Background In elderly patients, especially those older than 80 years, atrial fibrillation （AF） is associated with an almost 25% in- creased risk of stroke. Stroke prophylaxis with anticoagulants is therefore highly ...Background In elderly patients, especially those older than 80 years, atrial fibrillation （AF） is associated with an almost 25% in- creased risk of stroke. Stroke prophylaxis with anticoagulants is therefore highly recommended. The prevalence of factors that have been associated with a lower rate of prescription and adherence to anticoagulant therapy in these patients is little known. The objective of this study was to explore the clinical characteristics of elderly subjects, with and without AF, consecutively admitted to an acute geriatric unit, discussing factors that may decrease the persistence on stroke prophylaxis therapy. We also highlight possible strategies to overcome the barriers conditioning the current underuse of oral anticoagulants in this segment of the population. Methods A retrospective observational study was performed on a cohort of elderly patients with and without AF admitted to the Acute Geriatric Unit of San Gerardo Hospital （Monza, Italy）. Results Compared to patients without AF （n = 1216）, those with AF （n = 403） had a higher Charlson Comorbidity Index （3 vs. 2, P 〈 0.001）, number of administered drugs （4 vs. 3, P 〈 0.001）, rate of heart failure （36.5% vs. 12%, P 〈 0.001） and chronic kidney disease （20.6 vs. 13.2, P 〈 0.001）. Many patients with AF were frail （54%） or pre-frail （29%）. Conclusions Elderly patients with AF have higher rates of conditions that affect adherence to traditional anticoagulant therapy （vitamin K antagonists, VKA）. New direct oral anticoagulants （DOAs） can help overcome this problem. In order to prescribe the most appropriate VKA or DOAs, with the best efficacy/safety profile and the highest compliance, a comprehensive geriatric assessment should always accompany the scores for thrombotic and hemorrhagic risk stratification.展开更多
Objective To establish a nomogram for predicting the distant metastasis risk of pancreatic neuroendocrine tumors(pNETs)in elderly patients.Methods We extracted data of patients with diagnosis of pNETs at age≥65 years...Objective To establish a nomogram for predicting the distant metastasis risk of pancreatic neuroendocrine tumors(pNETs)in elderly patients.Methods We extracted data of patients with diagnosis of pNETs at age≥65 years old between 1973 and 2015 from the Surveillance,Epidemiology,and End Results(SEER)database.All eligible patients were divided randomly into a training cohort and validation cohort.Uni-and multivariate logistic regression analyses were performed on the training cohort to identify independent factors for distant metastasis.A nomogram was developed based on the independent risk factors using rms packages of R software,and was validated internally by the training cohort and externally by the validation cohort using C-index and calibration curves.Results A total of 411 elderly patients were identified,of which 260 were assigned to training cohort and 151 to validation cohort.Univariate and multivariate logistic regression analyses indicated the tumor site(body/tail of pancreas:odds ratio[OR]=2.282;95%confidence interval[CI]:1.174–4.436,P<0.05),histological grade(poorly differentiated/undifferentiated:OR=2.600,95%CI:1.266–5.339,P<0.05),T stage(T2:OR=8.913,95%CI:1.985–40.010,P<0.05;T3:OR=11.830,95%CI:2.530–55.350,P<0.05;T4:OR=68.650,95%CI:8.020–587.600,P<0.05),and N stage(N1:OR=3.480,95%CI:1.807–6.703,P<0.05)were identified as independent risk factors for distant metastasis of pNETs in elderly.The nomogram exhibited good predicting accuracy,with a C-index of 0.809(95%CI:0.757–0.861)in internal validation and 0.795(95%CI:0.723–0.867)in external validation,respectively.The predicted distant metastasis rates were in satisfactory agreement with the observed values by the calibration curves.Conclusion The nomogram we established showed high discriminative ability and accuracy in evaluation of distant metastasis risk in elderly pNETs patients,and could provide a reference for individualized tumor evaluation and treatment decision in elderly pNETs patients.展开更多
Elderly patients over 65, especially those over 75 years are more vulnerable to being prescribed inappropriate medications because of the high incidence of co-medication in this population resulting from the presence ...Elderly patients over 65, especially those over 75 years are more vulnerable to being prescribed inappropriate medications because of the high incidence of co-medication in this population resulting from the presence of multiple chronic diseases and also age-related changes in pharmacokinetics and pharmacodynamics. The aim at this study was to explore the habits of taking medications without recommendation fracture among older patients, to determine which medications are most often used without prescription, and if there is difference in this habits considering gender and age of respondents. Methods： A cross-sectional study was conducted by interviewing all patients 〉 65 years that have arrived from 01.10. to 15.12.2015 in one ambulance of the Health Center of Mostar using the adapted questionnaire made out for the research. 90 questionnaires were properly filled for analysis, 60.0% were women and 40.0% of them were men. There was 45.6% respondents between 65 and 75 years, and 54.4% 76 years and above. Resaults： 15.6% of respondents said that they don＇t take their therapy regularly. Women compared to men, significantly more often use non-prescription drugs （P = 0.007）. Analgesics and sedatives are more often used as non-prescription drugs, compare to supplements （P = 0.002）. Conclusion： This study, although conducted on a small sample should be an alarm for general practitioners. They should think more about adverse effects of drugs on the aged, and use Beers criteria in every day practice. In addition, pharmacists should respect the legislation and not sell drugs without doctor＇s prescription to which it applies.展开更多
Objective: To investigate if electroacupuncture(EA) preconditioning can mitigate cognitive impairments and reduce the incidence of postoperative cognitive dysfunction(POCD) following knee replacement and its safety am...Objective: To investigate if electroacupuncture(EA) preconditioning can mitigate cognitive impairments and reduce the incidence of postoperative cognitive dysfunction(POCD) following knee replacement and its safety among elderly.Methods: Totally 60 participants met the inclusion criteria were enrolled in a randomized controlled trial a ratio of 1:1, with 30 cases allocated to the treatment group and 30 cases allocated to the control group, respectively. The participants in the treatment group were provided with real-EA therapy whereas participants in control group were provided with placebo-EA therapy(Streitberger Placebo-needle). In both groups, Tou sanshen(头三神)acupoints, including Sìshéncōng(四神聪EX-HN1), Sh6 ntíng(神庭 GV24),and bilateral Běnsh6 n(本神GB13) were adopted as the main acupoints, while Bǎihui(百会GV20), bilateral Hégǔ(合谷Ll4), and bilateral Tàich6 ng(太冲LR3) were adopted as matching acupoints. Interventions were offered 5 days prior to the surgery, once daily, and continued for total 5 days. The global scores of MiniMental State Examination(MMSE), and levels of serum inflammatory cytokines including interleukin 1β(IL-1β) and tumor necrosis factor-α(TNF-α), and S100-β protein were observed at 24 h prior to the surgery, and postoperative 24 and 72 h respectively for assessing the incidence of POCD and the severity of cognitive impairments among patients. Meanwhile, adverse effects were monitored and recorded.Results:(1) Compared with baseline, MMSE global scores in both treatment and control groups markedly decreased at postoperative 24 h. MMSE global scores in treatment group decreased from 29.43 ±0.97 to27.10 ±1.95 while that in control group decreased from 29.27 ± 1.01 to 26.83 ± 2.25(all ?P< 0.05), and this trend continued until postoperative 72 h(at postoperative 72 h, MMSE global scores in treatment group was 26.53 ±2.26 versus 24.79 ±3.03 in control group). Moreover, decline in control group was more significant than that in treatment group at postoperative 72 h(P<0.05).(2) Compared with baseline, levels of serum IL-1β, TNF-α and S100-β in both groups increased markedly at postoperative 24 and 72 h. IL-1β in treatment group increased from 43.13 ±5.51 to 73.13 ±2.32 at postoperative 24 h and reached 83.17 士 5.95 at postoperative 72 h, while IL-1β in control group increased from 44.87 土 5.83 to91.10 ±3.55 at postoperative 24 h and reached 111.93 ±9.18 at postoperative 72 h;TNF-α in treatment group increased from 51.27 士 6.48 to 88.80 ± 3.55 at postoperative 24 h and reached 94.37 ± 5.22 at postoperative 72 h, while TNF-α in control group increased from 52.07 ±7.48 to 116.37 ±3.14 at postoperative24 h and reached 121.40 ±3.68 at postoperative 72 h(both ?P< 0.05), furthermore, increases of IL-1β and TNF-α levels in control group were more significant(P<0.05). Statistical difference in level of S100-β was not observed(P>0.05).(3) There was no statistical difference in POCD incidence at postoperative 24 h and postoperative 72 h between two groups(P> 0.05), though the incidence of POCD in patients receiving real-EA therapy was indeed much lower than that in patients receiving placebo-EA therapy, particularly at postoperative 72 h(POCD incidence rate at postoperative 24 h in treatment group was 26.67%, 30.00%in control group;POCD incidence rate at postoperative 72 h in treatment group was 30.00%, 46.67% in control group).(4) No serious adverse events were reported in this trial. No one dropped out from this trial.Conclusion: EA preconditioning can mitigate cognitive impairments at post-knee replacement surgery 24 and 72 h in elderly through inhibiting expression of inflammation. However, there is insufficient evidence to support that EA pretreatment can reduce the incidence of POCD.展开更多
文摘Background In elderly patients, especially those older than 80 years, atrial fibrillation （AF） is associated with an almost 25% in- creased risk of stroke. Stroke prophylaxis with anticoagulants is therefore highly recommended. The prevalence of factors that have been associated with a lower rate of prescription and adherence to anticoagulant therapy in these patients is little known. The objective of this study was to explore the clinical characteristics of elderly subjects, with and without AF, consecutively admitted to an acute geriatric unit, discussing factors that may decrease the persistence on stroke prophylaxis therapy. We also highlight possible strategies to overcome the barriers conditioning the current underuse of oral anticoagulants in this segment of the population. Methods A retrospective observational study was performed on a cohort of elderly patients with and without AF admitted to the Acute Geriatric Unit of San Gerardo Hospital （Monza, Italy）. Results Compared to patients without AF （n = 1216）, those with AF （n = 403） had a higher Charlson Comorbidity Index （3 vs. 2, P 〈 0.001）, number of administered drugs （4 vs. 3, P 〈 0.001）, rate of heart failure （36.5% vs. 12%, P 〈 0.001） and chronic kidney disease （20.6 vs. 13.2, P 〈 0.001）. Many patients with AF were frail （54%） or pre-frail （29%）. Conclusions Elderly patients with AF have higher rates of conditions that affect adherence to traditional anticoagulant therapy （vitamin K antagonists, VKA）. New direct oral anticoagulants （DOAs） can help overcome this problem. In order to prescribe the most appropriate VKA or DOAs, with the best efficacy/safety profile and the highest compliance, a comprehensive geriatric assessment should always accompany the scores for thrombotic and hemorrhagic risk stratification.
文摘Objective To establish a nomogram for predicting the distant metastasis risk of pancreatic neuroendocrine tumors(pNETs)in elderly patients.Methods We extracted data of patients with diagnosis of pNETs at age≥65 years old between 1973 and 2015 from the Surveillance,Epidemiology,and End Results(SEER)database.All eligible patients were divided randomly into a training cohort and validation cohort.Uni-and multivariate logistic regression analyses were performed on the training cohort to identify independent factors for distant metastasis.A nomogram was developed based on the independent risk factors using rms packages of R software,and was validated internally by the training cohort and externally by the validation cohort using C-index and calibration curves.Results A total of 411 elderly patients were identified,of which 260 were assigned to training cohort and 151 to validation cohort.Univariate and multivariate logistic regression analyses indicated the tumor site(body/tail of pancreas:odds ratio[OR]=2.282;95%confidence interval[CI]:1.174–4.436,P<0.05),histological grade(poorly differentiated/undifferentiated:OR=2.600,95%CI:1.266–5.339,P<0.05),T stage(T2:OR=8.913,95%CI:1.985–40.010,P<0.05;T3:OR=11.830,95%CI:2.530–55.350,P<0.05;T4:OR=68.650,95%CI:8.020–587.600,P<0.05),and N stage(N1:OR=3.480,95%CI:1.807–6.703,P<0.05)were identified as independent risk factors for distant metastasis of pNETs in elderly.The nomogram exhibited good predicting accuracy,with a C-index of 0.809(95%CI:0.757–0.861)in internal validation and 0.795(95%CI:0.723–0.867)in external validation,respectively.The predicted distant metastasis rates were in satisfactory agreement with the observed values by the calibration curves.Conclusion The nomogram we established showed high discriminative ability and accuracy in evaluation of distant metastasis risk in elderly pNETs patients,and could provide a reference for individualized tumor evaluation and treatment decision in elderly pNETs patients.
文摘Elderly patients over 65, especially those over 75 years are more vulnerable to being prescribed inappropriate medications because of the high incidence of co-medication in this population resulting from the presence of multiple chronic diseases and also age-related changes in pharmacokinetics and pharmacodynamics. The aim at this study was to explore the habits of taking medications without recommendation fracture among older patients, to determine which medications are most often used without prescription, and if there is difference in this habits considering gender and age of respondents. Methods： A cross-sectional study was conducted by interviewing all patients 〉 65 years that have arrived from 01.10. to 15.12.2015 in one ambulance of the Health Center of Mostar using the adapted questionnaire made out for the research. 90 questionnaires were properly filled for analysis, 60.0% were women and 40.0% of them were men. There was 45.6% respondents between 65 and 75 years, and 54.4% 76 years and above. Resaults： 15.6% of respondents said that they don＇t take their therapy regularly. Women compared to men, significantly more often use non-prescription drugs （P = 0.007）. Analgesics and sedatives are more often used as non-prescription drugs, compare to supplements （P = 0.002）. Conclusion： This study, although conducted on a small sample should be an alarm for general practitioners. They should think more about adverse effects of drugs on the aged, and use Beers criteria in every day practice. In addition, pharmacists should respect the legislation and not sell drugs without doctor＇s prescription to which it applies.
基金Supported by Key and Weak Discipline Construction Project(Gerontology of TCM),Shanghai Municipal Commission of Health and Family Planning(2015ZB050)Project of Science and Technology Commission of Shanghai Municipality(16401902600)~~
文摘Objective: To investigate if electroacupuncture(EA) preconditioning can mitigate cognitive impairments and reduce the incidence of postoperative cognitive dysfunction(POCD) following knee replacement and its safety among elderly.Methods: Totally 60 participants met the inclusion criteria were enrolled in a randomized controlled trial a ratio of 1:1, with 30 cases allocated to the treatment group and 30 cases allocated to the control group, respectively. The participants in the treatment group were provided with real-EA therapy whereas participants in control group were provided with placebo-EA therapy(Streitberger Placebo-needle). In both groups, Tou sanshen(头三神)acupoints, including Sìshéncōng(四神聪EX-HN1), Sh6 ntíng(神庭 GV24),and bilateral Běnsh6 n(本神GB13) were adopted as the main acupoints, while Bǎihui(百会GV20), bilateral Hégǔ(合谷Ll4), and bilateral Tàich6 ng(太冲LR3) were adopted as matching acupoints. Interventions were offered 5 days prior to the surgery, once daily, and continued for total 5 days. The global scores of MiniMental State Examination(MMSE), and levels of serum inflammatory cytokines including interleukin 1β(IL-1β) and tumor necrosis factor-α(TNF-α), and S100-β protein were observed at 24 h prior to the surgery, and postoperative 24 and 72 h respectively for assessing the incidence of POCD and the severity of cognitive impairments among patients. Meanwhile, adverse effects were monitored and recorded.Results:(1) Compared with baseline, MMSE global scores in both treatment and control groups markedly decreased at postoperative 24 h. MMSE global scores in treatment group decreased from 29.43 ±0.97 to27.10 ±1.95 while that in control group decreased from 29.27 ± 1.01 to 26.83 ± 2.25(all ?P< 0.05), and this trend continued until postoperative 72 h(at postoperative 72 h, MMSE global scores in treatment group was 26.53 ±2.26 versus 24.79 ±3.03 in control group). Moreover, decline in control group was more significant than that in treatment group at postoperative 72 h(P<0.05).(2) Compared with baseline, levels of serum IL-1β, TNF-α and S100-β in both groups increased markedly at postoperative 24 and 72 h. IL-1β in treatment group increased from 43.13 ±5.51 to 73.13 ±2.32 at postoperative 24 h and reached 83.17 士 5.95 at postoperative 72 h, while IL-1β in control group increased from 44.87 土 5.83 to91.10 ±3.55 at postoperative 24 h and reached 111.93 ±9.18 at postoperative 72 h;TNF-α in treatment group increased from 51.27 士 6.48 to 88.80 ± 3.55 at postoperative 24 h and reached 94.37 ± 5.22 at postoperative 72 h, while TNF-α in control group increased from 52.07 ±7.48 to 116.37 ±3.14 at postoperative24 h and reached 121.40 ±3.68 at postoperative 72 h(both ?P< 0.05), furthermore, increases of IL-1β and TNF-α levels in control group were more significant(P<0.05). Statistical difference in level of S100-β was not observed(P>0.05).(3) There was no statistical difference in POCD incidence at postoperative 24 h and postoperative 72 h between two groups(P> 0.05), though the incidence of POCD in patients receiving real-EA therapy was indeed much lower than that in patients receiving placebo-EA therapy, particularly at postoperative 72 h(POCD incidence rate at postoperative 24 h in treatment group was 26.67%, 30.00%in control group;POCD incidence rate at postoperative 72 h in treatment group was 30.00%, 46.67% in control group).(4) No serious adverse events were reported in this trial. No one dropped out from this trial.Conclusion: EA preconditioning can mitigate cognitive impairments at post-knee replacement surgery 24 and 72 h in elderly through inhibiting expression of inflammation. However, there is insufficient evidence to support that EA pretreatment can reduce the incidence of POCD.
