Therapeutic effect of interventional therapy for unprotected left main coronary artery lesions in aged patients

Objective To assesse the therapeutic effect of interventional therapy in aged patients with unprotected left main coronary artery （UPLM） lesions. Methods A total of 61 patients who were over 60 years and accepted interventional therapy of UPLM from January 2012 to November 2013 in our hospital were followed up for average 14.6 months by telephone call or outpatient visits. We analyzed the clinical features data of the interventional therapy and assessed the factors that likely influenced the clinical prognosis. Results The average age of the 61 patients was 73.9 years. The average left ventricular ejection fraction （LVEF） was 47.7%. The median of the estimated glomerular filtration rate （eGFR） was 52 mL/min per 1.73 mmz. The average SYNTAX score was 27.4 and the median of stent length was 36 mm. The cumulative incidence of cardiac death at 30 days and major adverse cardiac events （MACE） after one year was 6.6% and 32.5% estimated by Kaplan-Meier plots respectively. No severe hemorrhagic complications were observed during follow-up period. On multivariate regression analysis with a COX proportional hazards model, LVEF was an independent predictor of cardiac death at 30 days [Hazard ratio （HR）： 0.7, P = 0.01]. As for MACE after one year, LVEF and eGFR were both independent predictors （HR： 0.91, P = 0.06 for LVEF, HR： 0.03, P = 0.097 for eGFR）. Conclusions The interventional therapy for UPLM was effective and safe in aged patients. LVEF was the only predictor of cardiac death at 30 days, while LVEF and eGFR were both independent predictors of MACE after one year.

Outcomes of cardiac surgery in senior aged patients with ventricular dysfunction:analysis of a large national database

OBJECTIVE In patients undergoing cardiac surgery,reduced preoperative ejection fraction(EF)and senior age are associated with a worse outcome.As most outcome data available for these patients are mainly from Western surgical populations involving specific surgery types,our aim is to evaluate the real-world characteristics and perioperative outcomes of surgery in senior-aged heart failure patients with reduced EF across a broad range cardiac surgeries.METHODS Data were obtained from the China Heart Failure Surgery Registry(China-HFSR)database,a nationwide multicenter registry study in China's Mainland.Multiple variable regression analysis was performed in patients over 75 years old to identify risk factors associated with mortality.RESULTS From 2012 to 2017,578 senior-aged(>75 years)patients were enrolled in China HFSR,21.1%of whom were female.Isolated coronary bypass grafting(CABG)were performed in 71.6%of patients,10.1%of patients underwent isolated valve surgery and 8.7%received CABG combined with valve surgery.In-hospital mortality was 10.6%,and the major complication rate was 17.3%.Multivariate analysis identified diabetes mellitus(odds ratio(OR)=1.985),increased creatinine(OR=1.007),New York Heart Association(NYHA)Class III(OR=1.408),NYHA class IV(OR=1.955),cardiogenic shock(OR,6.271),and preoperative intra-aortic balloon pump insertion(OR=3.426)as independent predictors of in-hospital mortality.CONCLUSIONS In senior-aged patients,preoperative evaluation should be carefully performed,and strict management of reversible factors needs more attention.Senior-aged patients commonly have a more severe disease status combined with more frequent comorbidities,which may lead to a high risk in mortality.

Percutaneous Cholecystomy Guided by Ultrasound for Acute Cholecystitis in High-risk Aged Patients

Objective The aim of the present study was to assess experience with percutaneous cholecystostomy (PC) in high risk aged patients with presumed acute cholecystitis. Methods\ PC was performed by transhepatic route under local anaesthesia guided by ultrasonography cholecystostomy catheters. The catheters used include the Cope loop(produced by Japan hakko). Results\ PC was performed successfully in all 18 patients, without immediate procedural or technical complications. Symptoms and clinical signs of cholecystitis resolved within 24 48 h after the procedures in all but one patient. Conclusion\ PC is a cost effective ,mini invasive, and reliable alternative to surgical placement of cholecystostomy tubes in critically ill patient. This study also can be used in hepatic abscess, obstructive jaundice and necrostic pancreatitis caused by stone or tumor.\;

The effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury

Objective To explore effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury. Methods 71 cases were divided into three groups according age: group A( 【 30 years) ,group B ( 30 ～ 50 years) 。

The finite element analysis of cemented long and short stem prosthetic replacement in aged patients with comminuted intertrochanteric fracture

Objective To investigate the stress distribution of the femur after cemented prosthetic replacement in aged patients with comminuted intertrochanteric fracture and to analyze the difference of stress distribution between cemented long

Effects of Physical Exercise and Music Therapy on Cognitive Aspects in Tunisian Patients with Mild Alzheimer’s Type Dementia

Aim: The objective of this research is to highlight the effectiveness of physical exercise and music therapy in older patients with Alzheimer’s disease (AD). Methods: Patients with a mild level of AD were included in this study, divided into the therapy group (TG;N = 30, aged 68 ± 3.2 years) and the control group (CG;N=30, aged 65 ± 2.6 years). The therapy group was enrolled in an exercise-training program (walking, resistance and balance exercises) combined with musical therapy for 10 weeks (three sessions of 60 minutes per week). The Control group was instructed to follow their daily rhythm of life (e.g., rest, reading) under the same conditions. The intervention program was enrolled under the supervision of;one psychologist;a neurologist;two music therapists, and two physiotherapists, all belonging to the same hospital unit. After 10 weeks of participation in the combined program, cognitive parameters were improved in the therapy group measured with the Behavior Pathology in Alzheimer Disease (BEHAVE-AD), (p < 0.05) for activity disturbance, diurnal rhythm disturbances, anxieties and phobias, affective disturbance. The percentage range of improvements is 1.07% to 2.96%. Results: Our results demonstrate that physical exercise combined with music therapy improves cognitive function in patients with Alzheimer’s disease. Conclusions: Physical exercise and music therapy are beneficial combined treatments for improving life quality in older patients. This approach may be useful to help patients with a mild level of Alzheimer’s disease improve their behavioral and psychological parameters.

Surgical results and prognosis of patients with primary bronchogenic carcinoma aged less than 30 years

Objective To investigate and analyze the clinical and pathological features of surgical treatment for primary bronchogenic carcinoma in adolescent patients. Methods A retrospective review is presented of patients less than 30 years with surgical treatment of bronchogenic

Efficacy and safety of telaprevir- and simeprevir-based triple therapies for older patients with chronic hepatitis C

AIMTo evaluate and compare the efficacy and safety of telaprevir (TVR)-and simeprevir (SMV)-based triple therapies in elderly patients, specifically patients aged 66 years or older. METHODSThe present study enrolled 112 and 76 Japanese patients with chronic hepatitis C virus genotype 1b infection who were treated with a 12-wk TVR-based or SMV-based triple therapy, respectively, followed by a dual therapy that included pegylated interferon α and ribavirin (RBV) for 12 wk. The patients were categorized into two groups according to age as follows: A younger group of patients aged ≤ 65 years old and an older group of patients aged > 65 years old. Among the patients treated with TVR-based triple therapy, 34 patients were included in the older group. The median ages were 56 years (range: 28-65 years) in the younger group and 69 years (range: 66-81 years) in the older group. Among the patients treated with SMV-based triple therapy, 39 patients were included in the older group. The median ages were 59 years (range: 36-65 years) in the younger group and 71 years (range: 66-86 years) in the older group. The clinical, biochemical and virological data were analyzed before and during treatment. RESULTSAmong the patients treated with the TVR-based triple therapy, no significant difference in the sustained virological response (SVR) was found between the younger (80.8%) and older (88.2%) groups. The SVR rates for patients with the interleukin 28B (IL28B) (rs8099917) TG/GG-genotypes (73.9% and 60.0% in the younger and older groups, respectively) were significantly lower than for patients with the IL28B TT-genotype (86.3% and 92.9%, respectively). The cumulative exposure to RBV for the entire 24-wk treatment period (as a percentage of the target dose) was significantly higher in the younger group than in the older group (91.7% vs 66.7%, respectively, P vs 81.9%, respectively). A multivariate analysis identified the TT-genotype of IL28B (OR = 8.160; 95%CI: 1.593-41.804, P = 0.012) and the adherence of RBV (> 60%) (OR = 11.052; 95%CI: 1.160-105.273, P = 0.037) as independent factors associated with the SVR. Adverse events resulted in discontinuation of the treatment in 11.3% and 14.7% of the younger and older groups, respectively. Among the patients treated with the SMV-based triple therapy, no significant difference in the SVR rare was found between the younger (81.1%) and older (82.1%) groups. The SVR rates for patients with the IL28B TG/GG-genotypes (77.8% and 64.7% in the younger and older groups, respectively) were significantly lower than for patients with the IL28B TT-genotype (88.2% and 100%, respectively). A multivariate analysis identified the TT-genotype of IL28B as an independent factor associated with the SVR (OR = 9.677; 95%CI: 1.114-84.087, P = 0.040). Adverse events resulted in discontinuation of the treatment in 7.0% and 14.3% of patients in the younger and older groups, respectively. CONCLUSIONBoth TVR- and SMV-based triple therapies can be successfully used to treat patients aged 66 years or older with genotype 1b chronic hepatitis C. Genotyping of the IL28B indicates a potential to achieve SVR in these difficult-to-treat elderly patients.

Correlation between social support and depression in elderly stroke patients in the sequelae stage from five communities of Shanghai, China

Using a convenience sampling method, 81 aged patients who were between 6 and 24 months post-stroke were selected from five communities of Shanghai, China. The correlations between social support and depression, as well as other influential factors, were investigated. Results revealed that 46% （37/81） of the stroke patients suffered from depression. Depression was correlated with social support total scores and the two domains of subjective support and utilization. Older age, male gender, low income, absence of spouse and cerebral hemorrhage were risk factors for depression and identify more vulnerable groups.

The Impact of Salivary pH Value and Dental Caries Index on Periodontal Status among Adult Age Groups of Patients from Aseer Region, Saudi Arabia

Background: The patients’ age is considered a modified risk factor that causes periodontal disease, dental caries, and their development. Objective: The present study was designed to evaluate the impact of salivary pH value and dental caries index on periodontal status among adult age groups of patients from Aseer region, Saudi Arabia. Methods: A cross-sectional analysis carried out in the college of dentistry, King Khalid University on 750 adult patients (400 males and 350 females). The adults patients were divided into three equal groups according to the patients’ age: group I (20 - 30 years), group II (31 - 40 years), and group III (41 - 50 years). Plaque index (PLI), gingival index (GI), clinical attachment loss (CAL), and the dental caries index (DMFT) recorded as well as salivary pH. All findings collected, then analyzed by an ANOVA test and the t-test. A p-value at <0.05 was considered a statistical significance level. Results: The clinical findings of the current study showed that there were statistically significant differences in the patients’ age of both males and females. Moreover, there were statistically significant differences in GI. On the other hand, there were highly statistically significant differences in PLI and DMFS, but there were no significant differences in CAL of both males and females Moreover, there were no statistically significant differences in salivary pH. Conclusion: We concluded that DMFT Index correlated to periodontal and oral health status and, it increased with the progression of the patient’s age and can be used in the epidemiological evaluation of periodontal and oral health status.

Ailogeneic hematopoietic cell transplantation for malignant hematological diseases in patients older than 50 years of age

Objective To investigate the efficiency and safety of allogeneic hematopoietic cell transplantation for malignant hematological diseases in patients older than 50 years of age. Methods From May 2002 to January 2010,35 patients P 】 50 years with malignant hematological diseases received allogeneic hematopoietic

提高医疗安全意识 注重老年患者围手术期质量管理

目的提高医疗安全意识,保障老年患者围手术期医疗质量。方法复习2008年度住院的老年手术患者病历1430份,从年龄、住院科室分布、基础疾病、术前检查、知情告知等方面进行分析。结果老年手术患者占全部手术病例的32.77%,60～75岁的老年患者占全部病例的70%,以入住普外科、泌尿外科、骨外科为主。患有基础疾病的老年患者占90.84%。手术、麻醉、特殊治疗同意书签署率达到100%,特殊检查同意书签署率却只有88.04%,而谈话记录仅占全部病例的39.72%。结论重建术前准备流程,加强对老年手术患者的围手术期管理,进一步提高医疗质量,保证医疗安全。

高龄合并慢性疾病食管癌患者围手术期处理

目的探讨高龄合并慢性疾病食管癌患者的围手术期处理。方法对2008年1月至2013年12月收治的35例合并慢性疾病的70岁以上食管癌患者术后恢复情况及效果进行回顾性分析。结果术后顺利康复26例,占74.3%;出现较重或严重并发症9例,经积极处理痊愈,无死亡。结论对有并发症的高龄食管癌手术患者根据其适应证选择合适的手术方式,围手术期采取积极的处理措施,手术是安全可行的,效果较好。

基于电子支气管镜的氨溴索肺泡灌洗联合自拟活血祛湿化痰方治疗老年COPD合并肺部感染的疗效及安全性分析

目的:探讨经电子支气管镜盐酸氨溴索肺泡灌洗疗法联合自拟活血祛湿化痰方治疗老年慢性阻塞性肺疾病(COPD)合并肺部感染的疗效与安全性。方法:选取医院收治的100例经临床检查及影像学检查明确诊断为老年COPD及肺部炎性病变患者,采用随机数表法将其分为观察组和对照组,每组50例。对照组采用常规对症治疗,观察组采取经电子支气管镜盐酸氨溴索气管肺泡灌洗联合自拟活血祛湿化痰方治疗,比较两组治疗效果及体内炎性反应情况。结果:治疗后观察组患者主要症状积分、次要症状积分、体征积分以及COPD评估测试(CAT)积分低于对照组,其差异有统计学意义(t=5.320,t=5.947,t=6.803;P<0.05);治疗后观察组血清超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、氧化氮(NO)和一氧化氮合成酶(NOS)水平高于对照组,而白细胞介素8(IL-8)水平明显低于对照组,其差异有统计学意义(t=22.731,t=25.413,t=14.996,t=15.602,t=-14.922;P<0.05);观察组治疗总有效率明显高于对照组,其差异有统计学意义(x2=5.995,P<0.05)。结论:基于电子支气管镜的盐酸氨溴索肺泡灌洗疗法联合自拟活血祛湿化痰方治疗老年COPD并肺部感染疗效可靠且安全性较高,能够有效改善患者呼吸功能以及体内炎性反应,具有临床应用价值。

Ethical dilemma of colorectal screening: What age should a screening colonoscopy start and stop?

Many advanced age patients who are diagnosed with colorectal cancer are often not offered surgical treatment due to presumed high risks of the procedure.While there is data to support surgical treatment of colorectal cancer in advanced age patients,screening colonoscopy is not currently recommended for patients older than 85 years.Moreover,recent studies concluded that the incidence of colorectal cancer in patients 80 years and older is increasing.This raises the concern that the current guidelines are withholding screening colonoscopy for healthy elderly patients.Another concern contrary to this would be the new trend of growing incidence of advanced colorectal cancer in the younger patient population.Together they raise the ethical dilemma of how to best utilize colonoscopies as well as surgical intervention,as they are limited resources.

居家护理干预对社区老年高血压患者血压和用药依从性的影响

目的对社区老年高血压患者应用居家护理干预的效果展开观察。方法将本社区78例高血压老年患者随机分为两组,应用居家护理干预的为观察组,采取常规社区护理的为对照组。统计两种护理方法的效果,并进行比较。结果观察组患者的血压控制效果及治疗依从性均显著优于对照组,数据差异有统计学意义(P<0.05)。结论通过对社区老年高血压患者展开居家护理干预,可对其血压进行有效控制,并促进其用药依从性的提高。

Extracorporeal Shock Wave Lithotripsy Treatment for Renal and Ureteral Stones in Duhok City

The present study reports the results of extracorporeal shock-wave lithotripsy treatment for renal and ureteral stones in Duhok city. The data were collected from the center of breakdown kidney stones in Duhok hospital. There were a total of 40 patients (25 males and 15 females) aged from 20 to 60 years old. The patients harboring (23 renal and 17 ureteral) stones of size ranged from 7.5 to 20 mm. Almost stones are of average size 9 mm and composed of uric acid, calcium and cystine stones. The study has been carried out by taking into consideration the parameters (type, sizes, composition and location of stone as well as region and ages of patients, also power, number of shock wave and sessions). The results show that the stones size increases according to increasing ages of patients (male and female) for uric acid ureter stone and calcium (renal, ureter) stones. Also (renal, ureter) stone size for patients aged from 20 to 30 years old increases from the minimum value for phosphate to maximum value for cystine stones, while for patients aged from 40 to 60 years old, the minimum size is obtained for calcium oxalate and the maximum size for calcium only. On the other hand, for uric acid stones of average size 9 mm, number of shock wave and sessions as well as the power required to breakdown the stones decrease nearly exponentially according to enhancing patients’ ages. At the same time, it's found that for adult patients (20 - 30 years old), number of sessions and the power of shock wave decrease also according to increasing size of calcium and cystine stones. Contrary to that, for the same ages and renal, uretral cysteine stones number of shock wave needed to breakdown large stones will be increased.

Malignant Tumors in Patients Aged 60 and Over: An Analysis of 208 Autopsy Cases.

From the autopsy of 617 cases aged 60 and over.208 cases with malignant tumor were found.The detection rate

老年骨折病人抑郁状况调查与护理对策

目的 探讨老年骨折病人抑郁的原因和护理对策。方法 对 2 0 8例住院老年骨折病人 ,应用抑郁自评量表和汉密斯顿抑郁量表进行调查和评估。结果 老年骨折病人大多处于不同程度的抑郁状态 (12 8/2 0 8,占 6 1 5 % ) ,抑郁的主要原因为担心治疗效果、疼痛及经济负担。结论 针对老年骨折病人的抑郁状况 ,给予正性心理护理和情感支持 ,能增强病人治病信心 ,促进康复。