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The purpose of this review is to summarize the current knowledge on three physiological determinants of oral drug absorption, i.e., gastric emptying, volumes and composition of luminal fluids, and intestinal permeability, in the advanced age population, so that potential knowledge gaps and directions for further research efforts are identified. Published data on gastric emptying rates in older people are conflicting. Also, there are significant knowledge gaps, especially on gastric motility and emptying rates of drugs and of non-caloric fluids. Compared with younger adults, volumes of luminal contents seem to be slightly smaller in older people. Our understanding on the impact of advanced age on luminal physicochemical characteristics is, at best, very limited, whereas the impact of (co)morbidities and geriatric syndromes in the advanced age population has not been addressed to date. The available literature on the effect of advanced age on intestinal permeability is limited, and should be approached with caution, primarily due to the limitations of the experimental methodologies used. ispartof: EUROPEAN JOURNAL OF PHARMACEUTICAL SCIENCES vol:187 ispartof: location:Netherlands status: accepted

Aim: Papillary thyroid carcinoma (PTC) and primary hyperparathyroidism (PHPT) are among the most common endocrine diseases. Although it has been shown that hyperparathyroidism may be associated with various cancers, the question of whether there is an association between hyperparathyroidism and PTC remains controversial. To evaluate the incidence of concomitant PTC among patients with PHPT and to identify possible risk factors for the development of PTC in these patients. Material and Method: The data of 543 patients who had been operated on due to PHPT in our institution were reviewed retrospectively. Patients who underwent thyroid surgery in conjunction with parathyroidectomy and patients whose diagnosis of PTC was confirmed histopathologically were compared in terms of their clinical, biochemical, and histopathological features. The prevalence of PTC found in patients with PHPT was compared with national rates to estimate standardized incidence ratios (SIRs). Results: Of the 456 PHPT patients enrolled in the study, 281 (61.6%) had concomitant thyroid nodules on thyroid ultrasonography, and PTC was detected in 53 (11.6%) patients during their thyroid surgeries. Compared to the general population, the incidence of papillary thyroid cancer was increased in both women and men with PHPT (SIR: 272.2, 95% CI: 201.6-360.0, p

Introduction and objective Although advanced age doesn’t seem to impair oncological outcomes after robot-assisted radical prostatectomy (RARP), elderly patients have increased rates of prostate cancer (PCa) related deaths due to a higher incidence of high-risk disease. The potential unfavorable impact of advanced age on oncological outcomes following RARP remains an unsettled issue. We aimed to evaluate the oncological outcome of PCa patients > 69 years old in a single tertiary center. Materials and methods 1143 patients with clinically localized PCa underwent RARP from January 2013 to October 2020. Analysis was performed on 901 patients with available follow-up. Patients ≥ 70 years old were considered elderly. Unfavorable pathology included ISUP grade group > 2, seminal vesicle, and pelvic lymph node invasion. Disease progression was defined as biochemical and/or local recurrence and/or distant metastases. Results 243 cases (27%) were classified as elderly patients (median age 72 years). Median (IQR) follow-up was 40.4 (38.7–42.2) months. Disease progression occurred in 159 cases (17.6%). Elderly patients were more likely to belong to EAU high-risk class, have unfavorable pathology, and experience disease progression after surgery (HR = 5.300; 95% CI 1.844–15.237; p = 0.002) compared to the younger patients. Conclusions Elderly patients eligible for RARP are more likely to belong to the EAU high-risk category and to have unfavorable pathology that are independent predictors of disease progression. Advanced age adversely impacts on oncological outcomes when evaluated inside these unfavorable categories. Accordingly, elderly patients belonging to the EAU high-risk should be counseled about the increased risk of disease progression after surgery.

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.

This study aimed to assess the effects of GH adjuvant therapy on the cumulative live birth rate in patients with poor embryo quality and to determine the characteristics of patients who are more responsive to GH. A retrospective cohort study was carried out in patients who have suffered from previous IVF failure due to poor embryonic development and underwent IVF with or without a 6-week pretreatment with GH in the subsequent cycle from January 2018 to December 2020. Clinical parameters including the cumulative live birth rate between the (−) GH and (+) GH groups were compared. Multivariate analysis was performed to ascertain associations between clinical parameters and cumulative live birth rate. Upon analysis of the clinical data from 236 IVF cycles, 84 patients received GH and 152 did not receive GH. In frozen embryo transfer cycles, compared with the (−) GH group, the implantation rate and live birth rate were significantly higher in the (+) GH group (p < 0.05). After adjusting for possible confounding factors, GH improved cumulative live birth per oocyte retrieval cycle by 1.96 folds (p = 0.032). Furthermore, when patients were subdivided based on age and BMI, a significant increase in the cumulative live birth rate was found in the (+) GH group of patients between 35 and 42 years old and BMI ≥ 24 kg/m2, respectively (p < 0.05). GH may increase the live birth rate in women who experienced IVF failure because of poor embryonic development, particularly in obese patients and women with advanced age.

BackgroundAlthough survival from colorectal cancer (CRC) has improved substantially in recent decades, people with advanced age still have a high likelihood of mortality from this disease. Nonetheless, few studies have investigated how cancer stage, subsite and comorbidities contribute collectively to poor prognosis of older people with CRC. Here, we decided to explore the association of age with mortality measures and how other variables influenced this association.MethodsUsing linkage of several administrative datasets, we investigated the risk of death among CRC cases during 2003–2014. Different models were used to explore the association of age with mortality measures and how other variables influenced this association.ResultsOur results indicated that people diagnosed at a young age and with lower comorbidity had a lower likelihood of all-cause and CRC-specific mortality. Aging had a greater association with mortality in early-stage CRC, and in rectal cancer, compared that seen with advanced-stage CRC and right colon cancer, respectively. Meanwhile, people with different levels of comorbidity were not significantly different in terms of their increased likelihood of mortality with advanced age. We also found that while most comorbidities were associated with all-cause mortality, only dementia [SHR = 1.43 (1.24–1.64)], Peptic ulcer disease [SHR = 1.12 (1.02–1.24)], kidney disease [SHR = 1.11 (1.04–1.20)] and liver disease [SHR = 1.65 (1.38–1.98)] were risk factors for CRC-specific mortality.ConclusionThis study showed that the positive association of advanced age with mortality in CRC depended on stage and subsite of the disease. We also found only a limited number of comorbidities to be associated with CRC-specific mortality. These novel findings implicate the need for more attention on factors that cause poor prognosis in older people.

Refereed/Peer-reviewed 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.

In recent decades, there has been a growing scientific interest in the psychological state of the elderly who lead an active lifestyle, as well as elderly and not very healthy people. Scientists are trying to answer the question: what can be offered to the elderly to overcome the problems that arise during the aging period. The process of recovery of the elderly after inpatient treatment is especially important., В последние десятилетия растет научный интерес к психологическому состоянию людей пожилого возраста, которые ведут активный образ жизни, а также людей пожилых и не очень здоровых. Ученые пытаются ответить на вопрос: что можно предложить людям пожилого возраста, для преодоления проблем, возникающих в период старения. Особенно важен процесс восстановления пожилых людей после стационарного лечения., Человеческий капитал, Выпуск 4 (172) 2023, Pages 193-199

Feeling safe in one’s place of residence is important for the well-being of older adults when ageing in place; in contrast, feeling unsafe is likely to have negative consequences for well-being while ageing. Although substantial knowledge of perceived unsafety has been accumulated within various disciplines, there are certain knowledge gaps related to perceived unsafety in older age. What perceived reasons for feeling unsafe are the most central to older adults? Can emotion regulation strengthen or buffer the negative effects of perceived unsafety on the well-being of older people? What differences exist among older adults regarding why they feel unsafe? This dissertation aimed to address these questions while investigating perceived unsafety and its associations with well-being in the context of ageing, focusing on senior apartment residents. This dissertation adopted an interdisciplinary approach integrating knowledge of perceived unsafety from psychology, gerontology, and criminology. The findings suggest that perceived unsafety in advanced age is a multifaceted phenomenon. Specifically, perceived unsafety could be explained by different perceived reasons (i.e., fear of crime, unattractive social climate in the neighbourhood, and inconvenient infrastructure at home; Study I). Furthermore, maladaptive cognitive emotion regulation strategies were associated with fear of crime and strengthened its negative association with life satisfaction (Study II). Moreover, distinct profiles of older adults could be identified based on compromises in their key life domains. Older adults belonging to different profiles differed in their perceived unsafety and well-being (Study III). Overall, this dissertation findings indicate that feeling unsafe is associated with being less satisfied with life, experiencing more anxiety and depressive feelings, and relying on more maladaptive emotion regulation strategies. Therefore, safety-promotion efforts are considered an important investment in the quality of life of older adults living in senior apartments., Att känna sig trygg i sin boendemiljö är en förutsättning för välmående hos äldre som åldras i hemmet. Motsatsen, upplevelsen av otrygghet, kan däremot inverka negativt under åldrandet. Trots att olika vetenskapliga discipliner har bidragit med betydelsefull kunskap om äldres otrygghet finns fortfarande ett antal kunskapsluckor inom forskningsfältet. Vilka centrala orsaker till otrygghet uppger äldre? Kan känsloreglering stärka eller buffra negativa effekter av upplevd otrygghet på äldres välmående? Vilka skillnader finns bland äldre när det gäller orsaker till upplevd otrygghet? Syftet med denna avhandling var att undersöka upplevd otrygghet och dess samband med välmående i relation till åldrande bland äldre i seniorboenden. Avhandlingen har en tvärvetenskaplig utgångspunkt och integrerar kunskap om upplevd otrygghet från psykologi, gerontologi och kriminologi. Resultaten tyder på att äldres upplevda otrygghet är ett mångfacetterat fenomen. Flera olika förklaringar framträdde till varför äldre upplever otrygghet, närmare bestämt rädsla för brott, oattraktivt socialt klimat i bostadsområdet och bristfällig infrastruktur i hemmet (Studie I). Vidare framkom att maladaptiva kognitiva känsloregleringsstrategier var kopplade till rädsla för brott, och förstärkte sambandet med bristande livstillfredsställelse (Studie II). Vidare kunde ett antal distinkta profiler av äldre identifieras, baserade på sårbarhetsfaktorer inom viktiga livsområden. Profilerna skiljde sig åt gällande upplevd otrygghet och välmående (Studie III). Sammantaget indikerar denna avhandling att upplevd otrygghet är förknippat med lägre livstillfredsställelse, ökad ångest och depressiva symptom och att i högre utsträckning förlita sig på maladaptiva känsloregleringsstrategier. Trygghetsfrämjande insatser kan således anses vara en viktig satsning för att öka livskvaliteten hos äldre i seniorboenden.

Cardiovascular disease is a major contributor to morbidity, mortality and quality of life in people aged 60 and over. However, this age group of patients was not sufficiently included in large studies, in this regard, the management of elderly patients is an urgent problem in modern medicine. The purpose of this review is to analyze of literature data on the characteristics comorbid pathology and senile asthenia as a predictor of unfavorable course and outcomes of acute myocardial infarction in patients 60 years of age and older. To analyze the literature, we searched for information on this issue in PubMed / MEDLINE, PMC, Web of Science, Scopus, The Сocrane Library. Recent research data show that there are plenty of risk factors for worsening the course of AMI in patients aged 60 and over. The most important of them are considered to be high comorbidity, multivessel lesion of several pools, the presence of senile asthenia. All together lead to difficulties in diagnosing myocardial infarction, to forced polypharmacy and in some cases refraining from early invasive strategy, which worsens the course of the disease, increases the duration of hospital treatment, leads to frequent complications, thereby affects the prognosis of the disease and leads to the development of early disability in patients 60 years of age and older In the vast majority of elderly patients, the development of acute myocardial infarction occurs against the background of a high prevalence of comorbid pathology, which in turn accelerates the development of senile asthenia and its progression.

Introduction: The objective of this work was to analyse the postoperative clinical results of patients surgically treated for colorectal cancer in relation to the results of the preoperative comprehensive geriatric evaluation. Methods: Observational study in which postoperative morbidity and mortality at 30 and 90 days were analysed in a cohort of patients surgically treated for colorectal cancer according to age groups: group 1) between 75 and 79 years old; group 2) between 80 and 84 years old, and group 3) >= 85 years old. In addition to the anaesthetic risk assessment, patients were assessed with the Karnofsky, Barthel and Pfeiffer indexes. Mortality at 30 and 90 days after surgery was analysed in relation to the results of the comprehensive evaluation. Results: A total of 227 patients with colorectal cancer were included in the study period: 91 in group 1, 89 in group 2 and 47 in group 3. There were statistically significant differences in mortality at 30 days (p = 0,029) but not at 90 days after surgery, according to age groups. Mortality at 90 days was significantly higher in patients with worse scores on the Karnofsky andBarthel scales. Conclusions: Comprehensive geriatric assessment using different scales is a good tool to assess postoperative mortality in the mid-term postoperative period. (C) 2020 Elsevier Espana, S.L.U. All rights reserved.

BackgroundOld age and the presence of aortic stenosis are associated with the unfolding of the intrathoracic aorta. This may result in increased difficulties navigating catheters from the right compared to the left radial approach.ObjectiveTo investigate whether increasing age or presence of severe aortic stenosis was associated with increased catheterization success rates from left (LRA) compared to right radial artery approach (RRA).MethodsWe compared coronary angiography success rates of RRA and LRA according to different age groups and in a subgroup of patients with severe aortic stenosis.ResultsA total of 21,259 coronary angiographies were evaluated. With increasing age, the first pass success rate from either radial access decreased significantly (p < 0.001). In patients aged p = 0.003). Patients aged ≥85 years received less contrast agent and had shorter fluoroscopy time when LRA was used [86.6 ± 41.1 vs. 99.6 ± 48.7 ml (p < 0.001) and 4.5 ± 4.1 min vs. 6.2 ± 5.7 min (p < 0.001), mean (±SD)]. In patients with severe aortic stenosis (n = 589) better first pass success rates were observed via LRA compared to the RRA route (91.9 vs. 85.1%, p = 0.037).ConclusionLRA, compared to RRA, is associated with a higher first-pass catheter success rate for coronary artery angiography in patients aged ≥85 years and those with severe aortic stenosis.

Background: Urinary tract infections (UTIs) are one of the most seen infection among community. Objectives: In this cross-sectional study we aimed to investigate the risk factors of multidrug-resistant (MDR) bacteria that caused community-acquired UTI (CA-UTI). Methods: Consecutive patients admitted to the Urology and Infectious Diseases policlinics with the diagnosis of CA-UTI were included in the study. A standard form including possible predisposing factors for MDR bacteria was applied. Results: In total, 240 patients (51.3% females) were enrolled in the study. The mean age of participants were 59.8 ± 18.3 years old. Escherichia coli (n =166; 69.2%)was the most frequently isolated bacteria and its incidence was higher in females than in males (p=0.01). In total, 129 (53.8%) of the identified pathogens were MDR bacteria. According to multivariate analysis, the use of antibiotics three or more times increased the risk of infection with MDR bacteria by 4.6 times, the history of urinary tract infection in the last 6 months by 2 times, being male and over 65 years old by 3 times. Conclusion: Doctors should consider prescribing broad-spectrum antibiotics in patients with severe UTIs with a history of UTI, advanced age, male gender, and multiple antibiotic usage, even if they have a CA-UTI. Keywords: Urinary tract infection; community acquired; multidrug-resistant; male; multiple antibiotic usage; advanced age.

Hypercholesterolaemic patients at an advanced age (>75 years) with and without known cardiovascular disease are at higher cardiovascular risk than younger subjects, and the frequency of vascular events in this group of the patient increases with increasing age. However, in clinical practice, these subjects are undertreated for various reasons: conservative cultural attitude, fear of side effects, doubts about efficacy, lack of specific trials. Two recent meta-analyses have shown that the use of lipid-lowering drugs is as safe and effective in this age group as in younger subjects. Subjects aged >75 years in primary prevention are poorly represented in trials but should be considered for treatment in daily clinical practice, because, in the risk assessment (SCORE algorithm), they are very often classified as intermediate or high risk but can also be reclassified at increased risk if an additional assessment step with clinical markers (diabetes and reduced glomerular filtrate) or cardiovascular imaging is used for the detection of subclinical atherosclerosis. Greater attention to treatment methods and monitoring of possible side effects is recommended, but the only limit to the treatment is its ‘futility’ in the fragile patient.

Some patients are more likely to have drug-induced diseases due to a number of risk factors, such as older age. The aim of the study was to analyse the effect of older age on pharmacokinetics and pharmacodynamics of medicines and the risk of developing drug-induced diseases. The analysis of scientific literature demonstrated that changes in the functions of body organs and systems caused by natural aging processes may potentially affect pharmacokinetics and pharmacodynamics of medicines and increase the risk of adverse drug reactions. For instance, older people have a decreased cardiac output both at rest and during exercise, weight loss, loss of elasticity of elastic vessels, a reduced number of functioning nephrons, poorer renal filtration capacity, decreased liver volume, a reduced number of functioning hepatocytes, decreased hepatic blood flow. These changes directly affect absorption, metabolism, distribution, and excretion of medicines, which in turn can affect their safety profiles. Consideration of age-related changes in the functions of body organs and systems, regular monitoring of the efficacy and safety of the prescribed medicine, changing the dosage regimen, and revision of the treatment sheet by healthcare professionals will help optimize pharmacotherapy and reduce the risk of adverse reactions and drug-induced diseases in older patients.

Aim. Purpose of the study. To study the clinical and functional features of the parameters of arterial stiffness in the elderly, depending on gender differences. Materials and methods. The study included 497 therapeutic patients aged from 60 to 74 years. The average age of the examined patients was 65.13.9 years. All patients underwent a comprehensive clinical and instrumental examination. The study of the parameters of arterial stiffness and central arterial pressure (BP) was carried out on the AngioScan-01 apparatus (AngioScan-Electronics, Russia). Depending on the sex differences, the entire sample was divided into two age-matched groups: women (n=287) and men (n=210). Results. In the group of women, systolic levels (13820 mm Hg vs 13419 mm Hg; p=0.018), central (13720 mm Hg vs 13319 mm Hg; p=0.024), average (469 mm Hg vs 456 mm Hg; p=0.018), pulse BP (5316 mm Hg vs 5014 mm Hg; p=0.038), the value of the double product (107.423.5 conventional units vs 101.422.5 conventional units; p=0.004), augmentation index (AI) [22.1 (13.5, 31,3)% vs 15.9 (8.8; 24.9)%; p=0.005], the increase index at a pulse frequency of 75 per minute [23.2 (16.0; 30.5)% vs 15.9 (9.2; 23.5)%; p=0.005] and systole duration in percent (35.505.60 vs 34.244.53; p=0.007) were significantly higher than in the group of men. In addition, men showed a statistically significant increase in the average value of the alternative stiffness index (9.762.61 vs 8.172.03; p=0.005) and the dependence of the AI on age (p0.05). At the same time, a statistically more significant correlation of central and peripheral hemodynamic parameters with the presence of elevated AI (p0.05) was recorded in the group of women. Conclusion. In older women, an increase in systolic, central, average, pulse BP is associated with an increase in AI and an increase in the magnitude of the double product. In the group of elderly men, the increase in the alternative vascular stiffness index contributes to an increase in the duration of the pulse wave. Statistically more pronounced correlation relationships between the value of the AI and clinical and hemodynamic parameters were recorded in elderly women.

A B S T R A C T Introduction. Old age is related to geriatric syndrome where there are several health problems that often occur related to a decrease in body function and an increase in the inflammatory process. Decrease in muscle mass, muscle strength and physical performance will lead to a condition of sarcopenia and frailty syndrome in the elderly. The importance of prevention so that sarcopenia does not occur in the elderly by evaluating the factors that can cause it, one of which is controlling nutritional factors (macro and micro nutrients), such as in research, namely omega-3 macronutrients. The purpose of this study was to determine the correlation between serum omega-3 levels with muscle mass, muscle strength, and physical performance in the elderly community at Moehammad Hoesin Hospital Palembang. Methods. This research is an observational analytic study with a cross-sectional approach which was conducted at the Integrated Geriatric Clinic Internal Medicine RSMH Palembang from November 2019 to November 2020. A sample of 21 people aged> 60 years was examined for muscle mass, muscle strength, physical performance and omega- levels. 3 serums. All data processing and analysis in this study used SPSS version 25 for Windows. Results. Of the 21 subjects, it was found that women were 19 people (90.5%) and 2 men (9.5%). The mean value of muscle mass was 37.65 ± 5.7, hand grip strength was 24.04 ± 5 kg, and walking speed was 6.72 ± 1.8 seconds per 6 meters. There were 11 subjects with low serum omega-3 levels of 485.25 ± 110.19 mg. There was a significant relationship between serum omega-3 levels and muscle mass (p = 0.041) with moderate correlation strength (r = 0.448). Conclusion: Muscle mass has a significant relationship with serum omega-3 levels in the elderly with moderate strength. Meanwhile, muscle strength and physical performance did not have a significant relationship.

Traballo Fin de Grao en Enfermaría. Curso 2021-2022 Introducción: España tiene una de las menores tasas de natalidad del mundo, causa directamente ligada al retraso de la edad media de la maternidad. El reemplazo generacional lleva sin cumplirse ya más de 30 años, ésta no es una situación coyuntural. - Objetivos: El objetivo general del trabajo expone las causas que llevan a las mujeres a tener a su primer hijo al final de su etapa fértil cada vez de manera más común. Los objetivos específicos se centran en dar a conocer las causas socioeconómicas que hace que las mujeres se queden embarazadas cada vez más tarde y, en analizar las causas fisiológicas que pueden afectar a que la mujer logre un embarazo exitoso cuando toma la determinación a una avanzada edad. - Metodología: Mediante la búsqueda en diferentes bases de datos y páginas webs donde se interpretaron y analizaron los datos de los artículos y guías sacados entre los años 2002-2022, acotando la búsqueda de información a partir de las palabras clave, se llegó a los diferentes artículos que se han usado finalmente para realizar este trabajo. - Resultados: Las razones laborales o de conciliación de la vida familiar y laboral, y las económicas, son las responsables de que las mujeres españolas tengan menos hijos de los que les gustaría o no los tengan. A ésto se le suma la falta de estabilidad en las parejas actuales. La disminución del éxito de muchos embarazos están estrechamente ligados al envejecimiento femenino. - Conclusiones: Las madres mayores de 35 años, presentan un mayor consumo de atención hospitalaria antes y después del embarazo. La infertilidad que se relaciona con la edad es cada vez más común y a veces ni los mejores tratamientos de reproducción asistida pueden hacer frente al paso de los años. Introdución: España ten unha das menores taxas de natalidade do mundo, causa directamente ligada ao retraso da idade media da maternidade. O reemplazoxeracional leva sen cumplirse xa máis de 30 anos, esta non é unha situación conxuntural. - Obxectivos: O obxectivo xeral do traballo expón as causas que levan ás mulleres a ter o seu primeiro fillo ao final da súa etapa fértil cada vez máis comunmente. Os obxectivos específicos céntranse en dar a coñecer as causas socioeconómicas de que as mulleres se queden embarazadas cada vez máis tarde, e en analizar as causas fisiolóxicas que poidan afectar a que a muller logre un embarazo exitoso cando toma a determinación a unha avanzada idade. - Resultados: As razóns laborais e de conciliacion da vida familiar e laboral, e as económicas, son as responsables de que as mulleres españolas teñan menos fillos dos que lles gustaría ou non os teñan. A isto súmaselle a falta de estabilidade nas parellas actuais. A disminución do éxito de moitos embarazos está estreitamente ligado ao envellecemento feminino. - Conclusións: As nais maiores de 35 anos, presentan un maior consumo de atención hospitalaria antes e despois do embarazo. A infertilidade que se relaciona coa idade é cada vez máis común e ás veces nin os mellores tratamentos de reprodución asistida poden facer fronte ao paso dos anos. Introduction: Spain has one of the lowest birth rates of the World, this is directly related with the delayed average of the childbearing age. Is more than 30 years since the generational replacement has not been supplied, this is not a conjunctural situation. - Objectives: the general objective of the review shows the reasons that make women take the decision of having their first son at the end of their fertile period in a more common way than the last years. The specific objectives are focused on showing the socioeconomic reasons that explain why women are getting pregnant later and later, and in analyzing the biological causes which can cause problems for them to get a successful pregnancy at an advanced age. - Methodology: this review has been made through the search in different databases and web pages where the data of the articles and guides have been taken between years2002-2022. The search was limited by key words, the articles that have been used to carry out this work were interpreted and analyzed. - Results: the reasons related with the job and family life reconciliation and economic reasons are the main responsibles for Spanish women having fewer children than they would like or directly not having them. Added to this is the lack of stability in nowadays couples. The decrease in the success of many pregnancies is closely linked to the female aging. - Conclusions: mothers over 35 years old, need a higher attention at the hospital before and after pregnancy. Age- related infertility is becoming more and more common and sometimes not even the best assisted reproductive treatments can cope with the passing of the years.

Refereed/Peer-reviewed Background: While age and stage at diagnosis are known to affect treatment choices and survival from colorectal cancer (CRC), few studies have investigated the extent to which these effects are influenced by comorbidity. In this study, we describe the occurrence of comorbidity in CRC cases in South Australia and associations of comorbidity with age, stage and the age-stage relationship. Furthermore, we report on the association of individual comorbidities with age and stage at diagnosis. Methods: The South Australian Cancer Registry (SACR) provided CRC data (C18-C20, ICD-10) for 2004–2013 diagnoses. CRC data were linked with comorbidity data drawn from hospital records and health insurance claims. Logistic regression was used to model associations of comorbidity with age and stage. Results: For the 8462 CRC cases in this study, diabetes, peptic ulcer disease, and previous cancers were the most commonly recorded co-existing conditions. Most comorbidities were associated with older age, although some presented more frequently in younger people. Patients at both ends of the age spectrum (

Unexplained infertile couples can have further expectant management before starting assisted reproductive treatments. However, ovarian reserve and in vitro fertilization (IVF) outcomes rapidly decline after 39 years or more. It is thus important to clarify whether a waiting policy is also appropriate for women of advanced age. Couples who had access to a waiting list for approximately 1 year before receiving reimbursed public IVF were compared with those paying for access to immediate treatment. To allow for comparisons between these two strategies, we followed up couples who opted to pay for 1 year after the last embryo transfer from their first cycle. We calculated the proportion of live births in both groups and compared these using logistic regression models and a two-sample Z test for equality of proportions. Six hundred thirty-five couples were evaluated. Out of 359 couples in the immediate group, 70 (19.5%) had a live birth of which 11 after natural conception and 59 after IVF. Out of 276 couples in the waiting group, 57 (20.7%) had a live birth of which 37 after natural conception and 20 after IVF. There was no statistically significant difference between the two strategies in terms of the crude cumulative live birth rate (cLBR). The adjusted odds ratio of 0.69 (95%CI:0.39-1.22) did not change this conclusion as our sensitivity analyses. The cLBR for the 'waiting before IVF' and the 'immediate' strategies were similar. Further studies are needed to better characterize couples affected by unexplained infertility in order to individualize treatment strategies.

Aim: Intravenous catheter use can cause various infections ranging from infection at the site of catheter entry to bacteremia and colonization. The purpose of this study was to identify the causative micro-organisms, and effects on morbidity-mortality of catheter-related bloodstream infections developing over the last five years. Material and Methods: Data for 194 patients who underwent central intravenous catheter insertion in our hospital’s intensive care unit and other departments between November 2014 and August 2019 were analyzed retrospectively. Blood samples taken from the catheter or the catheter tip, and blood samples collected simultaneously from the peripheral vein were included in the study, and culture results were recorded. Patients’ demographic data and the effects of the factors identified on morbidity and mortality were subjected to statistical analysis. Results: Ninety-two (47.4%) of the 194 patients included in the study were female and 102 (52.6%) were male, and mortality rate was 62.4% (n=121). The frequency of underlying medical conditions such as asthma, congestive heart failure, and cerebrovascular event, and receiving treatments such as immunosuppression, transfusion, tracheostomy, nasogastric tube, and mechanical ventilation were higher in mortal cases than non-mortal cases. A total of two hundred and forty microorganisms were detected in 194 patients, 121 (50.4%) of which were Gram negative bacteria, while 68 (28.3%) were Gram positive bacteria, and 51 (21.3%) were Candida species. Conclusion: As a result, it was observed that the advanced age, underlying diseases and presence of resistant microorganisms were higher in mortal cases.

Objective: To evaluate the effect of age on recurrence and progression in patients with primary and non-muscle invasive bladder cancer (NMIBC). Material and Methods: The records of patients who underwent transurethral bladder tumor resection (TUR-BT) for primary bladder tumor between 2005-2010 were retrospectively reviewed. Patients who had NMIBC after the first TUR-BT and without extra-bladder involvement were included in the study. The patients were grouped in terms of age (under 60 years, 60-70 years, over 70 years), sex, tumor size (below and above 3 cm); the number of tumors (between 1, 2-7 and> 7); stage (Ta and T1) and grade (G1, G2 and G3). Results: A total of 316 patients were included in the study. Recurrence was seen in 226 (71.5%) and progression 71 patients (22.5%). Univariate analysis showed that age (> 70), tumor number (> 1), size (> 3 cm), stage (T1) and grade (G3) are effective in the development of recurrence and progression. Kaplan-Meier analysis showed that there was a significant difference between the age groups in terms of time to recurrence (p = 0.001), as age increased the probability of recurrence increased and time to recurrence decreased. There was a significant difference between the groups in the progression analysis and that the risk of progression increased with age and the time to progression decreased (p = 0.004). Conclusions: We found that the probability of recurrence and progression was significantly increased with age, especially over 70 years of age, in patients with NMIBC.

Doxorubicin is the most effective single agent in the treatment of non‐Hodgkin's lymphoma (NHL). Its use is limited because of the cardiac toxicity primarily in elderly patients (pts) and in pts with history of cardiac disease. Liposomal doxorubicin has been proven to reduce cardiotoxicity. The aim of this retrospective study was the use of nonpeghylated liposomal doxorubicin (NPLD) in term of efficacy, response rate and incidence of cardiac events. We retrospectively collected the experience of 33 Hematological Italian Centers in using NPLD. Nine hundred and forty‐six consecutive pts treated with R‐COMP (doxorubicin was substituted with NPLD, Myocet) were collected. Median age was 74 years, the reasons for use of NPLD were: age (466 pts), cardiac disease (298 pts), uncontrolled hypertension (126 pts), other reasons (56 pts). According to clinicians' evaluation, 49.9% of pts would not have used standard doxorubicin for different situations (age, cardiomyopathy, previous use of doxorubicin, and uncontrolled hypertension). Overall 687 pts (72.6%) obtained a complete remission (CR). About 5% (n = 51) of subjects developed major cardiotoxic events including heart failure (N = 31), ischemic heart disease (N = 16), acute heart attack (N = 3), and acute pulmonary oedema (N = 1). After a median follow‐up of 32 months, 651 pts were alive and the overall survival (OS) was 72%. After a median observation period of 23 months disease free survival (DFS) was 58%. Either in univariate or in multivariate analysis OS and DFS were not significantly affected by age or cardiac disease. Our findings strongly support that including R‐COMP is effective and safe when the population is at high risk of cardiac events and negatively selected. Moreover, the use of this NPLD permitted that about half of our population had the opportunity to receive the best available treatment.

Objective To compare the efficiency between on- and off-pump coronary artery bypass grafting (CABG) in elderly patients by propensity score matching (PSM). Methods From June 2014 to June 2019, a total of 301 patients (older than 70 years) undergoing CABG in our department were recruited in this study. For 51 patients underwent off-pump CABG (OPCABG), they were 44 males and 7 females, at an age of 70 to 83 (73.31±2.73) years. Another 51 patients including 46 males and 5 females, aged 70-78 (72.82±1.86) years, were selected from the remaining 250 patients treated with on-pump CABG (ONCABG) by PSM. Postoperative recovery was analyzed and compared between the 2 groups. Results There were no statistical differences in the mortality and cases needing intra-aortic balloon pump between the OPCABG and the ONCABG groups. But the former group had shorter endotracheal intubation (10.64±5.07 vs 15.07±5.35 h, P=0.000), less drainage volume at the day after surgery (307.15±132.16 vs 480.78±130.42 mL, P=0.000), and lower percentage of the patients needing continuous renal replacement therapy when compared with the ONCABG group. Conclusion Both OPCABG and the ONCABG surgeries are effective treatment for the elderly patients with coronary heart disease. However, OPCABG is superior to ONCABG in accelerating postoperative recovery and reducing postoperative complications.

A large-scale epidemic of type 2 diabetes mellitus (T2DM) is observed with advanced ageing worldwide. The prevalence of T2DM significantly increases with age. Therefore, this review aimed to summarise the data on T2DM in advanced and older aged patients. The primary geriatric syndromes, which should be considered for the management of older patients (cognitive impairment, sarcopenia, orthostatic hypotension, falls, urinary incontinence, senile asthenia, etc.), are presented. The causes of the high risk for hypoglycaemia in elderly patients are analysed. Improving the treatment for T2DM is a priority of modern medicine. Using antihyperglycaemic therapy is especially difficult in this population due to the high risk of hypoglycaemia and the multi-organ pathology leading to polypharmacy. Therefore, special attention is paid to treatment recommendations. Hypoglycaemic drugs used in elderly patients should be low risk of hypoglycaemia, without nephro- and hepatic toxicity, safe for cardiovascular organs, easy to administer. Furthermore, advantages and limitations of using various groups of hypoglycaemic drugs in elderly patients are discussed. DPP-4 inhibitors are also considered in detail. Modern data on mechanisms of hypoglycaemic action of DPP-4 inhibitors are presented. Possibilities of using sitagliptin in elderly patients were also considered. Finally, evidence-based studies demonstrating the obvious advantages of sitagliptin for the treatment of T2DM in the elderly and advanced aged population are discussed.

Background The incidence of breast cancer rises dramatically with age, and numerous studies have reported the benefits of post mastectomy radiotherapy in both young and elderly breast cancer patients. The limited numbers of radiotherapy machines and the conventional fractionation schedule which are of long duration make access to radiotherapy more difficult especially among the elderly in Nigeria. Hypo fractionated radiotherapy offers an alternative option (with a shorter duration and comparable side effects and outcomes) to conventional radiotherapy as reported in western literatures. Such studies are grossly lacking in a sub-Saharan African country like Nigeria, hence the need for this study. Methods In this retrospective study, the records of 83 elderly patients with stages II and III breast cancer that were treated with radiotherapy in the Radiotherapy and Oncology Department of UDUTH, Sokoto, Nigeria, from January 2015 to February 2019 were evaluated. Radiotherapy was given at a dose of 45 Gy in 18 fractions of 2.5 Gy to the chest wall and the regional lymph nodes over a period of 3.5 weeks. The end point was freedom from any grade 3 or higher toxicities and disease free survival at 2 years. Results Majority, 67 (80.7%) of the 83 patients had invasive ductal carcinoma which were not otherwise specific. About two-thirds of the patients (69.9%) had the disease located in the right breast. After a 24 month follow up, there were no grade 3 or 4 toxicities. Forty-two (50.6%) and 16 (19.2%) patients had grade 2 skin and nausea/vomiting toxicities respectively. Eighty (96.4%) were disease free at 24 months, 3 (3.6%) patients had local recurrence, while 1 (1.2%) had distant metastasis to the lungs. The two years overall survival rate was 90%. Conclusions Hypofractionated radiotherapy in elderly breast cancer patients proved to be comparable to conventional radiotherapy in terms of toxicities and outcome in our center.

Deterioration in overall health, hormonal disturbances, and erectile dysfunction (ED) contributes to limitations in sexual activity in the elderly, which is further limited by incorrect beliefs about the hazards of sexual activity in cardiac patients. We aimed to analyze the occurrence of ED in elderly men, their perception of the relevance of good sexual function, and their expectations of physicians. A cross-sectional study encompassed 731 patients with coronary artery disease (CAD) subjected to cardiac rehabilitation. Demographic data and data on modifiable risk factors and patient expectations were collected. ED was assessed using the IIEF-5 questionnaire. Relationships among the risk factors for ED, occurrence of ED, and patient expectations, as well as the changes in the indicators between 2012 and 2016, were analyzed. The mean age of men was 70.7 ± 5.1 years. The prevalence of ED was 93.0%. The IIEF-5 score was significantly associated with age, tobacco smoking, exercise tolerance, time to diagnosis of CAD, and treatment with calcium channel blockers and diuretics. Patients declared that sexual activity was overall important (47.9%) or very important (25.6%). Three hundred and sixty (49.3%) patients expected their physician to show interest in their sexual health, but the topic was addressed in only 12.5%. Over the past few years, we have observed an increase in the awareness and importance of sexual health as well as a significant increase in patients' expectations of physicians to show interest in their sexual health. Patients' expectations of discussing and receiving treatment for ED remain an unmet medical need.

İmmunglobulin-(Ig) A vasküliti çocukluk çağında daha sık ve benign seyir gösterirken, erişkin başlangıç daha nadirdir ve ağır seyretmektedir. Amacımız, merkezimizdeki IgA vaskülitli erişkin hastaların ayrıntılı klinik özellikleri, uzun dönem renal tutulum sonuçlarını ve prognozlarını retrospektif olarak belirlemekti. Çalışmaya IgA vasküliti tanı kriterlerini karşılayan 52 hasta alındı. Hastaların çoğunluğu erkek (37 vs 15, %71,2 vs %28.8) ve ortalama yaş 45 ± 18 yıl olarak bulundu. Renal tutulumu olan 20 hastanın, 12’sine (%23,1) renal biyopsi yapılmış ve IgA nefropatisi ile uyumlu saptanmıştır. 5 hastada kronik renal yetmezlik (KRY) gelişti ve bunların 3’ünde hemodiyaliz desteğinin en az bir kez gerektiği görüldü. 9 (%17,3) hastada relaps gözlendi (5’i renal, 3’ü cilt ve 1’i gastrointestinal). İleri yaş (>65) olanlarda başvuru sırasında akut böbrek yetmezliği (%50 vs %10 p:0,002) ve nefrotik düzeyde proteinüri (%75 vs %32,5 p:0,028) daha yüksek oranda tespit edildi. Bu grupta KRY gelişme riski (%33,3 vs %2,5 p65) ve renal tutulum, KRY gelişimi ve ölüm için önemli bir kriter olarak tespit edilmiştir. Bu nedenle ileri yaşta başlayan ve renal tutulumu olan hastalar KRY gelişimi ve kötü prognoz açısından dikkatle takip edilmelidirler, Immunglobulin (Ig)- A vasculitis is seen more common in children characterized with benign course, whereas adult-onset form is relatively rare but may be associated with severe organ involvement and worse prognosis. Our aim in this study is to retrospectively evaluate clinical features, detailed analysis of renal involvement, longterm renal outcome and overall prognosis in adult-onset IgA vasculitis patients followed in our center. 52 cases fullfilling selection criterias were included in this study. Majority of patients were male (37 vs 15, 71,2% vs 28.8%) and mean age was calculated 45 ± 18 years. Among 20 patients who had renal involvement, renal biopsy was performed in 12 (23,1%), consistent with IgA nephropathy. Chronic kidney disease (CKD) developed in 5, and among those, hemodialysis was needed in 3 at least once through entire following period. Relaps was seen in 9 (17,3%) with the sites of distribution as following; 5 renal, 3 skin and 1 gastrointestinal. Acute kidney injury (50% vs 10% p:0,002) and nephrotic range proteinuria (75% vs 32,5% p:0,028) at admission were found significantly higher in patients at advanced age (>65). CKD development (33,3% vs 2,5%, p65) and renal involvement seem to be significant risk factors for the development of CKD and overall mortality, consistent with the literature. Therefore, these patients should be monitored closely.

The aim of this study is to investigate the problems and needs of users with advanced age and cognitive impairment regarding the design and operation of daily living products. Television remote controls and an electric rice cooker were applied as the research tools, and focus group interviews with control older adults and interviews with individuals with MCI or mild dementia were conducted regarding the operation of the products. The control participants stressed that the operating procedures should not be excessively complex, the number of functions and buttons should not be overly high, and buttons and text should be enlarged. For those with MCI or mild dementia, in addition to the size and number of buttons, text size, and functions, their operation of product interfaces was affected by the complexity of the operating procedures. The solutions recommended by the participants included interface design involving direct operation and voice control.

Acute cardiac damage can be induced by isoproterenol injections in animals. The associated inflammatory response could be reflected in the brain as neuroinflammation, with potential consequences for brain function and behavior. Although cardiac responses are reported age and sex-related, for neuroinflammation and brain function this is virtually unknown. Therefore, cardiac damage and its consequences for neuroinflammation, brain function and behavior were compared in aged male and female rats. Wistar rats of 24 months of age were treated with isoproterenol (ISO, twice s.c.) or saline. Four weeks after injections, exploratory behavior and short-term memory were tested. Then, rats were sacrificed. Hearts were collected to measure cardiac damage. Brain tissue was collected to obtain measures of neuroinflammation and brain function. In male-, but not in female rats, ISO induced significant cardiac damage. Accordingly, mortality was higher in males than in females. Baseline hippocampal microglia activity was lower in females, while ISO induced neuroinflammation in both sexes, Hippocampal brain-derived neurotrophic factor expression appeared lower in females, without effects of ISO. In the open field test, ISO-treated males, but not females, displayed anxiety-like behavior. No effects of ISO were observed on short-term memory in either sex. In conclusion, sex dimorphism in effects of ISO was observed for cardiac damage and open field behavior. However, these effects could not be related to differences in hippocampal neuroinflammation or neuronal function.

Background Whether the fundamental hematological and cardiac variables determining cardiorespiratory fitness and their intrinsic relationships are modulated by major constitutional factors, such as sex and age remains unresolved. Methods Transthoracic echocardiography, central hemodynamics and pulmonary oxygen (O2) uptake were assessed in controlled conditions during submaximal and peak exercise (cycle ergometry) in 85 healthy young (20–44 year) and older (50–77) women and men matched by age-status and moderate-to-vigorous physical activity (MVPA) levels. Main outcomes such as peak left ventricular end-diastolic volume (LVEDVpeak), stroke volume (SVpeak), cardiac output (Qpeak) and O2 uptake (VO2peak), as well as blood volume (BV), BV–LVEDVpeak and LVEDVpeak–SVpeak relationships were determined with established methods. Results All individuals were non-smokers and non-obese, and MVPA levels were similar between sex and age groups (P ≥ 0.140). BV per kg of body weight did not differ between sexes (P ≥ 0.118), but was reduced with older age in men (P = 0.018). Key cardiac parameters normalized by body size (LVEDVpeak, SVpeak, Qpeak) were decreased in women compared with men irrespective of age (P ≤ 0.046). Older age per se curtailed Qpeak (P ≤ 0.022) due to lower heart rate (P 2peak was reduced with older age in both sexes (P peak than older men (P = 0.024). Conclusions Sex and age interact on the crucial circulatory relationship between total circulating BV and peak cardiac filling, with older women necessitating more BV to fill the exercising heart than age- and physical activity-matched men.

Perioperative neurocognitive disorder (PND) is a growing concern, affecting several million elderly patients each year in the United States, but strategies for its effective prevention have not yet been established. Humeidan et al. recently demonstrated that preoperative brain exercise resulted in a decrease in postoperative delirium incidence in elderly surgical patients, suggesting the potential of presurgical cognitive optimization to improve postoperative cognitive outcomes. This brief review summarizes the current knowledge regarding preoperative cognitive optimization and highlights landmark studies, as well as current ongoing studies, as the field is rapidly growing. This review further discusses the benefit of cognitive training in non-surgical elderly populations and the role of cognitive training in patients with preexisting cognitive impairment or dementia. The review also examines preclinical evidence in support of cognitive training, which can facilitate understanding of brain plasticity and the pathophysiology of PND. The literature suggests positive impacts of presurgical cognitive optimization, but further studies are encouraged to establish effective cognitive training programs for elderly presurgical patients.

ObjectiveTo assess and compare the feasibility of progestin-primed ovarian stimulation (PPOS) protocol with mild stimulation protocol for advanced age women with diminished ovarian reserve (DOR) undergoing their first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle.MethodsPatients aged ≥35 years and DOR undergoing their first IVF/ICSI cycle were enrolled in this retrospective cohort study: 139 and 600 patients underwent the PPOS and mild stimulation protocols, respectively. The primary outcomes were cumulative clinical pregnancy rate (CCPR) and cumulative live birth rate (CLBR). The secondary outcomes were the number of oocytes retrieved and top-quality embryos.ResultsThere was nearly no significant difference of baseline characteristics between the two groups. Although a greater amount of total gonadotropin (1906.61 ± 631.04 IU vs. 997.72 ± 705.73 IU, PPPP=0.038) was greater in the PPOS group than the mild stimulation group. Meanwhile, the incidence of premature luteinizing hormone (LH) surge rate was significantly lower in the PPOS group (0.7% vs.8.3%, P=0.001) than the mild stimulation group. However, there was no significant difference in conservative CCPR, conservative CLBR, optimistic CCPR, and optimistic CLBR between the two groups (all P>0.05). A multivariate logistic regression model showed significant positive effects of the number of retrieved oocytes and number of top-quality embryos on conservative CCPR (OR=1.236, 95%CI: 1.048–1.456, P=0.012, OR=2.313, 95%CI: 1.676–3.194, PP=0.020, OR=2.634, 95%CI: 1.799–3.857, PPPConclusionThe PPOS protocol is an effective alternative to the mild stimulation protocol for advanced age patients with DOR, as it provides comparable reproductive outcomes and better control of premature LH surge. Further, more oocytes and top-quality embryos were obtained in the PPOS group, which had a positive association with conservative CCPR and CLBR.

Advanced age represents one of the major risk factors for Parkinson’s Disease. Recent biomedical studies posit a role for microRNAs, also known to be remodelled during ageing. However, the relationship between microRNA remodelling and ageing in Parkinson’s Disease, has not been fully elucidated. Therefore, the aim of the present study is to unravel the relevance of microRNAs as biomarkers of Parkinson’s Disease within the ageing framework. We employed Next Generation Sequencing to profile serum microRNAs from samples informative for Parkinson’s Disease (recently diagnosed, drug-naïve) and healthy ageing (centenarians) plus healthy controls, age-matched with Parkinson’s Disease patients. Potential microRNA candidates markers, emerging from the combination of differential expression and network analyses, were further validated in an independent cohort including both drug-naïve and advanced Parkinson’s Disease patients, and healthy siblings of Parkinson’s Disease patients at higher genetic risk for developing the disease. While we did not find evidences of microRNAs co-regulated in Parkinson’s Disease and ageing, we report that hsa-miR-144-3p is consistently down-regulated in early Parkinson’s Disease patients. Moreover, interestingly, functional analysis revealed that hsa-miR-144-3p is involved in the regulation of coagulation, a process known to be altered in Parkinson’s Disease. Our results consistently show the down-regulation of hsa-mir144-3p in early Parkinson’s Disease, robustly confirmed across a variety of analytical and experimental analyses. These promising results ask for further research to unveil the functional details of the involvement of hsa-mir144-3p in Parkinson’s Disease.

Введение. Саркопения представляет собой потерю мышечной силы и массы у пожилых людей и является распространенным заболеванием, при этом она связана с несколькими неблагоприятными последствиями для здоровья. Часто у пожилых людей происходит сочетание саркопении с артериальной гипертензией. Малоизученность данного патофизиологического континуума связана с отсутствием доступных диагностических тестов и единых диагностических критериев. Цель: Выявить наиболее типичные варианты патофизиологического геронтологического континуума при развитии саркопении в пожилом возрасте. Материалы и методы: В исследование было включено 2145 людей пожилого возраста методом случайного отбора из обратившихся амбулаторно пациентов в течение 2012-2021 гг. Они были разделены на 5 групп в зависимости от варианта развития саркопении в соответствии с опросником SARC-F. Результаты исследования: наиболее характерным патологическим состоянием, которое в наибольшей степени распространено у людей с саркопенией, являлась артериальная гипертензия. Причем при всех функциональных вариантах саркопении ее распространенность находилась примерно на одном уровне в 66,7+1,4 – 68,3+1,4 случаев на 100 чел. Обсуждение: Показано, что люди с артериальной гипертензией уже имеют динапенические явления. В этой связи была изучена артериальная жесткость сосудов с помощью анализа результатов определения скорости распространения пульсовой волны путем синхронной регистрации сфигмограмм сонной, лучевой и бедренной артерий. Обнаружено, что вследствие патологической жесткости сосудов у пациентов с артериальной гипертензией в сочетании с саркопенией скорость пульсовой волны увеличивалась до 13,2±0,2 м/с, в то время как у пациентов с артериальной гипертензией, но без саркопении данный показатель находился на верхней границе нормы и составил 11,8±0,2 м/с. Выводы: Наиболее характерным патологическим состоянием, которое в наибольшей степени распространено у людей пожилого возраста с саркопенией, являлась артериальная гипертензия. Причем при всех функциональных вариантах саркопении ее распространенность находилась примерно на одном уровне. При этом само течение артериальной гипертензии было более неблагоприятным при наличии саркопении, чем при ее отсутствии., Introduction. Sarcopenia represents a loss of muscle strength and mass in the elderly and is a common condition, with several adverse health effects associated with it. Often in the elderly there is a combination of sarcopenia with arterial hypertension. The lack of knowledge of this pathophysiological continuum is associated with the lack of available diagnostic tests and uniform diagnostic criteria. Purpose: to identify the most typical variants of the pathophysiological gerontological continuum in the development of sarcopenia in old age. Materials and methods: the study included 2145 elderly people by random selection from outpatients during 2012-2021. They were divided into 5 groups depending on the development option of sarcopenia according to the SARC-F questionnaire. Results: the most characteristic pathological condition, which is most common in people with sarcopenia, was arterial hypertension. Moreover, with all functional variants of sarcopenia, its prevalence was approximately at the same level in 66.7 + 1.4 68.3 + 1.4 cases per 100 people. Discussion: It has been shown that people with hypertension already have dinapenic phenomena. In this regard, arterial stiffness of vessels was studied by analyzing the results of determining the pulse wave propagation rate by synchronous recording of sphygmograms of the carotid, radial and femoral arteries. It was found that due to abnormal vascular stiffness in patients with hypertension in combination with sarcopenia, the pulse wave rate increased to 13,2±0,2 m/s, while in patients with hypertension, but without sarcopenia, this indicator was at the upper limit of normal and amounted to 11,8±0,2 m/s. Conclusions: The most characteristic pathological condition, which is most common in elderly people with sarcopenia, was arterial hypertension. Moreover, with all functional variants of sarcopenia, its prevalence was approximately at the same level. At the same time, the course of arterial hypertension itself was more unfavorable in the presence of sarcopenia than in its absence.

Introduction:the objectives of the present study were to determine the mortality rate in patients over 60 years of age with COVID-19 and to identify risk factors. Methods:the present historical cohort study took place at the Kinshasa University Hospital (KUH), DRC. Older patients admitted from March 2020 to May 2021 and diagnosed COVID-19 positive at the laboratory were selected. The relationship between clinical and biological risk factors, treatment, and in-hospital mortality was modeled using Cox regression. Results:of two hundred and twenty-two patients at least 60 years old, 97 died, for a mortality rate of 43.69%. The median age was 70 years (64-74) with extremes of 60 to 88 years. Low oxygen saturation of < 90% (aHR 1.69; 95% CI [1.03-2.77]; p=0.038) was an independent predictor of mortality. The risk of death was reduced with corticosteroid use (aHR 0.54; 95% CI [0.40-0.75]; p=0.01) and anticoagulant treatment (aHR 0.53; 95% CI [0.38-0.73]; p=0.01). Conclusion:mortality was high in seniors during COVID-19 and low oxygen saturation on admission was a risk factor for mortality. Corticosteroid therapy and anticoagulation were protective factors. These should be considered in management to reduce mortality.

Background Delirium has a prevalence of 14%-56% in hospitalized patients. Risk factors include advanced age, invasive mechanical ventilation (IMV), and prolonged intensive care unit stay. Neuropsychiatric symptoms have been reported to be related to autoimmune responses secondary to Guillain-Barré syndrome (GBS) with direct involvement of the central nervous system (CNS) or to delirium. There are few reports of the frequency of delirium in patients with Guillain-Barré syndrome (GBS). Objective To describe the frequency of and the characteristics associated with delirium in patients with GBS. Material and methods A single-center, cross-sectional study was conducted in patients with GBS diagnosis between 2015 and 2019. The diagnosis of delirium was made using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria. We compared patients with and without delirium. We performed both univariate and multivariate analyses to identify factors associated with delirium. Results A total of 154 patients with GBS were included, of which 20 (12.9%) fulfilled the DSM-5 criteria for delirium. The mean age was 48 ± 18.2 years, the median Medical Research Council (MRC) sum score was 29.3 ± 21.9 points, 65% had bulbar cranial nerve involvement, 80% presented autonomic dysfunction, 85% had ICU stay, and 90% had mechanical ventilation requirement. In the multivariate analysis, the following were the independent factors for the development of delirium: age ≥ 60 (odds ratio (OR): 5.7; 95% confidence interval (CI): 1.3-23.5), time from symptom onset to admission ≤ 3 days (OR: 4.3; 95% CI: 1.1-16.8), autonomic dysfunction (OR: 13.1; 95% CI: 3-56), and intensive care unit stay (OR: 9.5; 95% CI: 2.1-42.6). Conclusion Delirium is not frequent in patients with Guillain-Barré syndrome. Patients with advanced age, rapid motor progression, bulbar cranial nerve involvement, prolonged intensive care unit stay, and mechanical ventilation need are more likely to present delirium.

A 96-year-old female with severe dementia complained of subacute onset of right arm swelling after sleep using her right arm as a pillow. Computed tomography and ultrasonography could not detect any significant findings. Nevertheless, her unilateral edema was similar to that of a venous disorder; therefore, we performed angiography of the brachial vein with the right arm in a normal position and in an abduction position; significant stenosis was seen in the latter position. We diagnosed her with venous thoracic outlet syndrome. This case was unique from the typical cases of venous thoracic outlet syndrome because of the subacute onset of symptoms, high age at onset, and discrepancies between ultrasonography and angiography findings. Dementia is the key factor explaining these features. The diagnosis of thoracic outlet syndrome is generally difficult. Although provocative physical examination maneuvers and ultrasonography are essential, dynamic testing with provocative maneuvers allows physicians to detect venous compression, even if it is difficult to capture with static imaging tests. Once the diagnosis and its etiology were confirmed, corresponding intervention, including physical therapy, is warranted.

The purpose of the study was to analyze the various causes of nasal defects seen in practice by plastic surgeons in the Department of Plastic Surgery, in a tertiary care North Indian Hospital. The study included all patients of any age and sex presenting to the outpatient department or emergency department with nose defects. The patients were enquired about the cause and history of their nasal defects. The most common etiologies of nasal defects seen were skin tumors of the nose, the most common one being the basal cell carcinoma (BCC) followed by squamous cell carcinoma (SCC), and congenital naevus. Both the malignancies BCC and SCC were seen in older age. While BCC was significantly more common in males, a specific gender preference could not be concluded in SCC. Trauma was the next most common cause and included road traffic accidents, assaults, and animal bites. These were more commonly seen in the youth and less commonly in geriatric or pediatric populations. Other less common causes of nasal defects included postburn lesions.

Background and aim: The incidence of periprosthetic femoral fractures (PFF) is increasing, as the incidence of total hip arthroplasty (THA) and the longevity of patients with in situ implants are increasing. PFF are characterized by remarkably high re-operation and mortality rates and substantial loss in function. Therefore, the aim of the present study was to review the outcome of the surgical treatment of 54 PFF after THA at a mean follow-up of 45 months. Methods: We retrospectively reviewed 54 surgically treated patients with PFF after THA from January 2005 to Dicember 2015 at a mean follow-up of 45 months (range 12-135 months). At final follow-up, the clinical outcome was measured using the Harris Hip score (HHS), the Karnofsky score (KS), while, the radiographic results were evaluated using the Beals and Tower’s criteria. Results: There were 13 post-operative complications that occurred in 10 patients with an overall re-operation rate of 11%. The mortality rate was 0% at 3 months and 3.7% at one year post-operatively. At final follow-up, the mean HHS was 64 (range 20-100) and the mean KS was 66 (range 30-100). The mean last HHS and KS of patients older than 75 years or with co-morbidities were lower than that of patients younger than 75 years or without co-morbidities (p0.05). There were no differences of the mean last HHS and KS of ORIF compared to stem revision of type B2 and B3 fractures (p>0.05). The radiolographic results were excellent in 89%, good in 9% and poor in 2% of patients. Conclusions: Although this study have shown that the surgical treatment of PFF was associated with a low re-operative rate, a good to excellent radiolographic results and a low mortality rate at 3 months and 1 year postoperatively, there was a marked functional deterioration in many patients. This decline of function could be attributed to the advanced age of patients and the presence of co-morbidities, whereas, fracture type according to the Vancouver classification, surgical treatment and complications had no effect. In this cohort of patients, ORIF could be a valid option for treating B2 and B3 type fractures with loosened stem.

A B S T R A C T Introduction Older people tend to have decreased activity and intake of macronutrients and micronutrients that are not in accordance with the body's needs. Research in 2017 on elderly men and women at the Center for Family Compensation (PUSAKA) in Central Jakarta showed that 80.2% of elderly people have vitamin D deficiency. Low serum levels of vitamin D in the body are the initial risk of decreased muscle mass and physical performance in old age. where there is a significant correlation between low serum vitamin D levels in the body with sarcopenia and mortality. The purpose of this study was to determine the correlation of vitamin D levels with muscle mass, muscle strength and physical performance in the elderly community at RSMH Palembang. Methods This research is a study analytic observation with a cross- sectional approach that was carried out at the Integrated Geriatric Clinic Internal Medicine RSMH Palembang from November 2019 to November 2020. A sample of 34 people aged> 60 years were examined for muscle mass, muscle strength, physical performance and serum vitamin D levels. All processing and analysis The data in this study used SPSS version 25 for Windows. Results From 34 subjects, it was found that there were 29 women (85.3%) and 5 men (14.7%). The mean value of muscle mass is38.76 ± 4.1 kg / m2, long runs within 6 meters 6.12± 0.9 m / sec, and hand grip strength 24.9 ± 5.2 kg. It was found that 18 (62.1%) female samples had vitamin D deficiency while 11 (37.9%) samples had vitamin D insufficiency. There was a significant correlation between muscle mass and hand grip strength with vitamin D with weak correlation strength and length of walking with vitamin D with moderate correlation strength.Conclusion There is a significant correlation between muscle mass and grip strength and walking time of 6 meters with vitamin D.

Given the significant increase in the frequency of atrial fibrillation (AF) in elderly and senile patients with confirmed coronary heart disease (CHD), the study of the relationship between the polymorphisms responsible for the functioning of the renin-angiotensinaldosterone system and the presence of this disease becomes relevant. Purpose of the study. To study the genetic polymorphism of the CYP11B2 gene in elderly patients with ischemic heart disease, as well as to identify the role of aldosterone synthetase in the development of AF in this category of patients. Materials and methods. The study included 140 patients of both sexes (54,3% – men), over the age of 60 years, with confirmed coronary artery disease and any form of AF (the last episode no later than 12 months from the date of inclusion in the study). 84 patients agreed to participate in the study of aldosterone synthase polymorphisms. The control group consisted of 34 patients who had no diagnosed non-infectious diseases at the time of the survey. Both groups were comparable in age and sex characteristics. Results. Comparative evaluation of the distribution of genotypes and alleles – C344/T of the aldosterone synthase gene among patients with AF+CHD and relatively healthy individuals revealed that in the first group, most patients had the CYP11B2 T/T genotype in 38,1% of cases, the incidence was higher, than in patients of the comparison group – 14,7% (OR = 3.44, CI 1.07-11.07, p = 0.038). The frequency of detection of genotypes of CYP11B2 С/T and CYP11B2 С/С did not significantly differ in the compared groups. In the group with AF+CHD, the T allele was significantly more common (53,6% vs. 35,3%; p

Au sein du corps humain, le cerveau constitue un organe particulier faisant l’objet de différentes conceptions et mesures scientifiques. Cet article propose d’aborder une partie de ces conceptions au prisme des recherches sur le grand âge et la longévité. En s’appuyant sur une analyse de la littérature en médecine, neuropsychologie, biologie et de psychologie expérimentale, l’article montre que les conceptions scientifiques du cerveau sont tout à la fois marquées par l’époque mais surtout par l’approche théorique et l’objet de la recherche dans lesquelles elles se trouvent prises. En cela, le cerveau est tantôt conçu comme un objet de mesure de l’âge en fonction de ses capacités d’homéostasie, de plasticité ou de résilience, tantôt comme un instrument support de la conscien­ce, de la personnalité ou d’un comportement favorable ou non au bien vieillir. Dans une conception biologique, le cerveau apparait comme l’organe à partir duquel il est possible de lier des manifestations biologiques et des mesures cliniques de la démence. Il n’est pas un “morceau” de corps comme les autres mais l’organe qui révèle la maladie, l’âge voire l’être. In the human body, the brain constitutes a particular organ that is the object of various conceptions and scientific measurements. This article proposes approaching some of these conceptions in the prism of research work on advanced age and longevity. In being based on an analysis of the literature in medicine, neuropsychology, biology and experimental psychology, the article shows that the scientific conceptions of the brain are at once marked by the period but above all by the theoretical approach and the goal of the research they find themselves involved in. In that regard, the brain is sometimes conceived of as an object of measurement of age in terms of its capacities for homeostasis, plasticity or resilience, and sometimes as a support instrument of the consciousness, the personality or a behaviour that is favourable or not to aging well. Within a biological conception, the brain appears as the organ based on which it is possible to link biological manifestations and clinical measurements of insanity. It is not a “piece” of the body like the others but the organ which reveals disease, age and even being.

The aim of research - to identify the features of the biomechanical parameters of the arteries of the brain in the II period of adulthood. Materials and methods. The samples of anterior (ACA), middle (MCA), posterior cerebral (PCA), posterior connective (PCoA), basilar arteries (BA) and intracranial parts of vertebral arteries (VA) seized at autopsy of 40 corpses of men andwomen aged 35-60 years were studied. In the longitudinal tension experiment on the tensile testing machine Tira Test studied the overall strength, tensile strength, maximum relative deformation and young's modulus of walls.Results. The paper describes the average values and variability parameters of the studied biomechanical parameters of arteries. The results of the comparative analysis with the average values typical for the population of adults aged 21-90 years are presented. Conclusion. Biomechanical properties of cerebral arteries are characterized by significant variability. The least changeable is the overall strength of the artery wall. The data obtained differ from the average values typical for the population of adults aged 21-90 years. The greatest differences were found for the ultimate strength of the vascular wall. In the II period of adulthood, this parameter in MCA, PCA, BA, ACA and BA is 8-15% more, and in PCoA is 22% less than the average value.

Objective This study was performed to investigate the relationship between the serum cystatin C (Cys C) level and acute coronary syndrome (ACS) in patients of advanced age. Methods The study included 184 patients with ACS and 46 healthy control subjects. Statistical analysis was performed using SPSS version 14.0 (SPSS Inc., Chicago, IL, USA). Results The serum Cys C level was significantly higher in patients with than without ACS (1.24 ± 0.30 vs. 1.42 ± 0.46 mg/L, respectively). Patients with more stenotic coronary arteries were significantly more likely to have higher median serum Cys C and creatinine levels and a lower estimated glomerular filtration rate. The multivariate logistic regression analysis demonstrated that the serum Cys C level was independently associated with the presence of ACS and the quantity of stenotic coronary arteries after adjustment for confounding factors. Additionally, the serum Cys C level was positively correlated with age, the creatinine level, and the N-terminal pro-B-type natriuretic peptide level in all patients but was negatively correlated with the estimated glomerular filtration rate. Conclusion A high serum Cys C level was independently associated with ACS and the quantity of stenotic coronary arteries in patients of advanced age regardless of renal function.

Age-related chromosomal aneuploidy is associated with the reduction of cohesin in meiosis. There are many complicated factors affecting the metabolism of cohesion, including the hyperactive separase, abnormal Shugoshin protein degradation, oxidative damage, increased intracellular pH in oocytes, abnormal metabolism of spindle assembly checkpoint, anaphase-promoting complex, and age-related reproductive hormones, which are summarized in the review.

The purple urine bag syndrome is an underrecognized but quite common condition, resulting in marked discoloration of the urine bag system due to bacterial metabolism. This syndrome is associated with advanced age and bedridden persons.

Background Prognostic implications of blood cholesterol may differ at different stages of life. This cohort study compares the value of total cholesterol (TC) readings earlier versus later in life for the prediction of coronary atherosclerosis, cardiovascular events, and cardiovascular death. Methods In a cardiovascular observation study (CVOS) we performed coronary angiography and prospectively recorded cardiovascular events in 1090 patients over up to 19 years. These patients had participated in a health survey (HS) 15 years prior to the CVOS baseline. TC was measured twice, first at the earlier HS and then later at CVOS recruiting. Findings Patients in the highest versus the lowest TC-category of the HS had an OR of 4.30 [2.41–7.65] for significant CAD at angiography, a HR of 1.74 [1.10–2.76] for cardiovascular events, and a HR of 7.55 [1.05–54.49] for cardiovascular death after multivariate adjustment. In contrast, TC as measured at the baseline of the CVOS was neither significantly associated with significant CAD (OR= 0.75 [0.49–1.13]) nor with cardiovascular events or death during follow-up (HR= 0.86 [0.62–1.18] and 0.79 [0.41–1.53], respectively). Moreover, the ESC/EAS-SCORE was found to be more powerful in predicting cardiovascular mortality when using earlier instead of later TC, with a continuous net reclassification improvement of 0.301 (p Interpretation Early measurement not only enables early intervention in keeping with the concept of lifelong exposure to atherogenic lipoproteins. These data also suggest that cardiovascular risk prediction is more accurate if using earlier in life TC readings. Funding The present study did not receive any particular funding

Purpose To evaluate the outcomes of high-grade T1 non-muscle-invasive bladder cancer treatment (NMIBC) in elderly patients over 80 years of age. Methods This is a retrospective single tertiary-centre study. Medical records of patients with T1 high-grade NMIBC treated with transurethral resection of the bladder tumour (TURBT) were reviewed. Among 269 patients with high-grade T1 NMIBC, 74 individuals were over 80 years of age at the time of surgery. Finally, 67 patients met the inclusion criteria. Results Only 47.8% of patients (N = 32) received at least five of the six instillations of the BCG immunotherapy induction course. Oncological outcomes were compared between patients who received at least the induction course of BCG and non-BCG-treated patients matched to each other based on age and Charlson comorbidity index. Thirty case–control pairs were included in the final analysis. Rates of disease recurrence (80% vs. 53%) and cancer-specific mortality (40% vs. 10%) were significantly higher in the group of patients who did not receive BCG. BCG therapy, Charlson comorbidity index, haemoglobin concentration and the number of tumours > 3 in TURBT constituted independent prognostic factors for cancer-specific survival (CSS). Conclusion BCG should be strongly recommended to patients with T1HG NMIBC despite advanced age and comorbidities. Already BCG induction improves CSS and reduces the recurrence rate in octogenarians with T1HG bladder cancer.

Background Severity of corona virus disease 2019 (COVID19) is presented with respiratory distress and requires mechanical ventilation. Advanced age is one of the significant risk factors of the worst prognosis and mortality in this disease. The aim of this study is to investigate the clinical parameter among COVID19 patients under mechanical ventilation in regard to the age groups. Method In this retrospective study, COVID19 patients under invasive mechanical ventilation at Shahid Beheshti Hospital in Qom were included. The patients were divided in two age groups, those aged ≥50 years and 0.05, respectively. Conclusions The findings of the study indicated that prognosis of COVID19 patients under invasive mechanical ventilation in terms of changes in clinical parameters might not be associated with the age.