AIM: To characterize the effects of age on clinical presentations and endoscopic diagnoses and to determine outcomes after endoscopic therapy among patients aged ≥ 65 years admitted for acute upper gastrointestinal b...AIM: To characterize the effects of age on clinical presentations and endoscopic diagnoses and to determine outcomes after endoscopic therapy among patients aged ≥ 65 years admitted for acute upper gastrointestinal bleeding (UGIB) compared with those aged < 65 years. METHODS: Medical records and an endoscopy data-base of 526 consecutive patients with overt UGIB admitted during 2007-2009 were reviewed. The initial presentations and clinical course within 30 d after endoscopy were obtained. RESULTS: A total of 235 patients aged ≥ 65 years constituted the elderly population (mean age of 74.2 ± 6.7 years, 63% male). Compared to young patients, the elderly patients were more likely to present with melena (53% vs 30%, respectively; P < 0.001), have comorbidities (69% vs 54%, respectively; P < 0.001), and receive antiplatelet agents (39% vs 10%, respectively; P < 0.001). Interestingly, hemodynamic instability was observed less in this group (49% vs 68%, respectively; P < 0.001). Peptic ulcer was the leading cause of UGIB in the elderly patients, followed by varices and gastropathy. The elderly and young patients had a similar clinical course with regard to the utilization of endoscopic therapy, requirement for transfusion, duration of hospital stay, need for surgery [relative risk (RR), 0.31; 95% confidence interval (CI), 0.03-2.75; P = 0.26], rebleeding (RR, 1.44; 95% CI, 0.92-2.25; P = 0.11), and mortality (RR, 1.10; 95% CI, 0.57-2.11; P = 0.77). In Cox's regression analysis, hemodynamic instability at presentation, background of liver cirrhosis or disseminated malignancy, transfusion requirement, and development of rebleeding were significantly associated with 30-d mortality. CONCLUSION: Despite multiple comorbidities and the concomitant use of antiplatelets in the elderly patients, advanced age does not appear to influence adverse outcomes of acute UGIB after therapeutic endoscopy.展开更多
Currently,scientific interest has focused on fat accumulation outside of subcutaneous adipose tissue.As various imaging modalities are available to quantify fat accumulation in partic-ular organs,fatty pancreas has be...Currently,scientific interest has focused on fat accumulation outside of subcutaneous adipose tissue.As various imaging modalities are available to quantify fat accumulation in partic-ular organs,fatty pancreas has become an important area of research over the last decade.The pancreas has an essential role in regulating glucose metabolism and insulin secretion by responding to changes in nutrients under various metabolic circumstances.Mounting evidence has revealed that fatty pancreas is linked to impairedβ-cell function and affects in-sulin secretion with metabolic consequences of impaired glu-cose metabolism,type 2 diabetes,and metabolic syndrome.It has been shown that there is a connection between fatty pancreas and the presence and severity of nonalcoholic fatty liver disease(NAFLD),which has become the predominant cause of chronic liver disease worldwide.Therefore,it is nec-essary to better understand the pathogenic mechanisms of fat accumulation in the pancreas and its relationship with NAFLD.This review summarizes the epidemiology,diagnosis,risk factors,and metabolic consequences of fatty pancreas and discusses its pathophysiology links to NAFLD.展开更多
文摘AIM: To characterize the effects of age on clinical presentations and endoscopic diagnoses and to determine outcomes after endoscopic therapy among patients aged ≥ 65 years admitted for acute upper gastrointestinal bleeding (UGIB) compared with those aged < 65 years. METHODS: Medical records and an endoscopy data-base of 526 consecutive patients with overt UGIB admitted during 2007-2009 were reviewed. The initial presentations and clinical course within 30 d after endoscopy were obtained. RESULTS: A total of 235 patients aged ≥ 65 years constituted the elderly population (mean age of 74.2 ± 6.7 years, 63% male). Compared to young patients, the elderly patients were more likely to present with melena (53% vs 30%, respectively; P < 0.001), have comorbidities (69% vs 54%, respectively; P < 0.001), and receive antiplatelet agents (39% vs 10%, respectively; P < 0.001). Interestingly, hemodynamic instability was observed less in this group (49% vs 68%, respectively; P < 0.001). Peptic ulcer was the leading cause of UGIB in the elderly patients, followed by varices and gastropathy. The elderly and young patients had a similar clinical course with regard to the utilization of endoscopic therapy, requirement for transfusion, duration of hospital stay, need for surgery [relative risk (RR), 0.31; 95% confidence interval (CI), 0.03-2.75; P = 0.26], rebleeding (RR, 1.44; 95% CI, 0.92-2.25; P = 0.11), and mortality (RR, 1.10; 95% CI, 0.57-2.11; P = 0.77). In Cox's regression analysis, hemodynamic instability at presentation, background of liver cirrhosis or disseminated malignancy, transfusion requirement, and development of rebleeding were significantly associated with 30-d mortality. CONCLUSION: Despite multiple comorbidities and the concomitant use of antiplatelets in the elderly patients, advanced age does not appear to influence adverse outcomes of acute UGIB after therapeutic endoscopy.
文摘Currently,scientific interest has focused on fat accumulation outside of subcutaneous adipose tissue.As various imaging modalities are available to quantify fat accumulation in partic-ular organs,fatty pancreas has become an important area of research over the last decade.The pancreas has an essential role in regulating glucose metabolism and insulin secretion by responding to changes in nutrients under various metabolic circumstances.Mounting evidence has revealed that fatty pancreas is linked to impairedβ-cell function and affects in-sulin secretion with metabolic consequences of impaired glu-cose metabolism,type 2 diabetes,and metabolic syndrome.It has been shown that there is a connection between fatty pancreas and the presence and severity of nonalcoholic fatty liver disease(NAFLD),which has become the predominant cause of chronic liver disease worldwide.Therefore,it is nec-essary to better understand the pathogenic mechanisms of fat accumulation in the pancreas and its relationship with NAFLD.This review summarizes the epidemiology,diagnosis,risk factors,and metabolic consequences of fatty pancreas and discusses its pathophysiology links to NAFLD.
