Relationship between platelet-lymphocyte ratio and carotid atherosclerosis in middle-aged and elderly patients with type 2 diabetes mellitus

Objective:To investigate the relationship between platelet-lymphocyte ratio(PLR)and carotid atherosclerosis(CAS)in middle-aged and elderly patients with T2DM.Methods:A total of 420 middle-aged and elderly patients with T2DM who were hospitalized in the Endocrinology Department of our hospital from September 2018 to September 2020 and were examined by ultrasound were selected as the subjects.The carotid artery intima-media thickness(CIMT)was examined by color Doppler ultrasonography,including normal CIMT group(n=111),CIMT thickening group(n=103)and CAS plaque group(n=206).The differences of serum PLR levels among the three groups were compared.Multivariate Logistic regression was used to analyze the relationship between PLR and CAS plaque formation.The receiver operating curve(ROC)was used to evaluate the value of multivariate Logistic regression model(Logit P)in the diagnosis of CAS lesions.Results:The mean value of PLR in CAS plaque group(127.86±48.54)was significantly higher than that in CIMT normal group(109.15±48.35).Multivariate Logistic regression analysis showed that after adjusting for other confounding factors,the increase of PLR was an independent risk factor for the occurrence of CAS plaque.ROC showed that the efficacy of multivariate Logit P model in the diagnosis of CAS plaque was(AUC=0.807,95%CI=0.759-0.858).Conclusions:PLR is one of the important risk factors for the occurrence of CAS lesions.At the same time,the multivariate Logistic regression model established in this study has clinical reference value in predicting CAS lesions in middle-aged and elderly patients with T2DM.

Effect of remimazolam vs. propofol on hemodynamics during general anesthesia induction in elderly patients: Single-center, randomized controlled trial

The current study aimed to compare the effects between remimazolam and propofol on hemodynamic stability during the induction of general anesthesia in elderly patients.We used propofol at a rate of 60 mg/(kg·h)in the propofol group(group P)or remimazolam at a rate of 6 mg/(kg·h)in the remimazolam group(group R)for the induction.A processed electroencephalogram was used to determine whether the induction was successful and when to stop the infusion of the study drug.We measured when patients entered the operating room(T_(0)),when the induction was successful(T_(1)),and when before(T_(2))and 5 min after successful endotracheal intubation(T_(3)).We found that mean arterial pressure(MAP)was lower at T_(1–3),compared with T_(0) in both groups,but higher at T_(2) in the group R,whileΔMAP_(T0–T2) andΔMAP_(max) were smaller in the group R(ΔMAP_(T0–T2):the difference between MAP at time point T_(0) and T_(2),ΔMAP_(max):the difference between MAP at time point T_(0) and the lowest value from T_(0) to T_(3)).Cardiac index and stroke volume index did not differ between groups,whereas systemic vascular resistance index was higher at T_(1–3) in the group R.These findings show that remimazolam,compared with propofol,better maintains hemodynamic stability during the induction,which may be attributed to its ability to better maintain systemic vascular resistance levels.

Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique

BACKGROUND Postoperative delirium,particularly prevalent in elderly patients after abdominal cancer surgery,presents significant challenges in clinical management.AIM To develop a synthetic minority oversampling technique(SMOTE)-based model for predicting postoperative delirium in elderly abdominal cancer patients.METHODS In this retrospective cohort study,we analyzed data from 611 elderly patients who underwent abdominal malignant tumor surgery at our hospital between September 2020 and October 2022.The incidence of postoperative delirium was recorded for 7 d post-surgery.Patients were divided into delirium and non-delirium groups based on the occurrence of postoperative delirium or not.A multivariate logistic regression model was used to identify risk factors and develop a predictive model for postoperative delirium.The SMOTE technique was applied to enhance the model by oversampling the delirium cases.The model’s predictive accuracy was then validated.RESULTS In our study involving 611 elderly patients with abdominal malignant tumors,multivariate logistic regression analysis identified significant risk factors for postoperative delirium.These included the Charlson comorbidity index,American Society of Anesthesiologists classification,history of cerebrovascular disease,surgical duration,perioperative blood transfusion,and postoperative pain score.The incidence rate of postoperative delirium in our study was 22.91%.The original predictive model(P1)exhibited an area under the receiver operating characteristic curve of 0.862.In comparison,the SMOTE-based logistic early warning model(P2),which utilized the SMOTE oversampling algorithm,showed a slightly lower but comparable area under the curve of 0.856,suggesting no significant difference in performance between the two predictive approaches.CONCLUSION This study confirms that the SMOTE-enhanced predictive model for postoperative delirium in elderly abdominal tumor patients shows performance equivalent to that of traditional methods,effectively addressing data imbalance.

Differences in insomnia-related self-reported outcomes among elderly hospitalized patients

Insomnia is among the most common sleep disorders worldwide.Insomnia in older adults is a social and public health problem.Insomnia affects the physical and mental health of elderly hospitalized patients and can aggravate or induce physical illnesses.Understanding subjective feelings and providing reasonable and standardized care for elderly hospitalized patients with insomnia are urgent issues.AIM To explore the differences in self-reported outcomes associated with insomnia among elderly hospitalized patients.METHODS One hundred patients admitted to the geriatric unit of our hospital between June 2021 and December 2021 were included in this study.Self-reported symptoms were assessed using the Athens Insomnia Scale(AIS),Generalized Anxiety Disorder Scale-7(GAD-7),Geriatric Depression Scale-15(GDS-15),Memorial University of Newfoundland Scale of Happiness(MUNSH),Barthel Index Evaluation(BI),Morse Fall Scale(MFS),Mini-Mental State Examination,and the Short Form 36 Health Survey Questionnaire(SF-36).Correlation coefficients were used to analyze the correlation between sleep quality and self-reported symptoms.Effects of insomnia was analyzed using Logistic regression analysis.RESULTS Nineteen patients with AIS≥6 were included in the insomnia group,and the incidence of insomnia was 19%(19/100).The remaining 81 patients were assigned to the non-insomnia group.There were significant differences between the two groups in the GDA-7,GDS-15,MUNSH,BI,MFS,and SF-36 items(P<0.05).Patients in the insomnia group were more likely to experience anxiety,depression,and other mental illnesses,as well as difficulties with everyday tasks and a greater risk of falling(P<0.05).Subjective well-being and quality of life were poorer in the insomnia group than in the control group.The AIS scores positively correlated with the GAD-7,GDS-15,and MFS scores in elderly hospitalized patients with insomnia(P<0.05).Logistic regression analysis showed that GDS-15≥5 was an independent risk factor for insomnia in elderly hospitalized patients(P<0.05).CONCLUSION The number of self-reported symptoms was higher among elderly hospitalized patients with insomnia.Therefore,we should focus on the main complaints of patients to meet their care needs.

Effect of Dexmedetomidine on Maintaining Perioperative Hemodynamic Stability in Elderly Patients:A Systematic Review and Meta-analysis

Objective Dexmedetomidine is a highly selective alpha-2 adrenergic receptor agonist with sedative and analgesic properties but without respiratory depression effect and has been widely used in perioperative anesthesia.Here we performed a systematic review and meta-analysis to evaluate the effect of dexmedetomidine on maintaining perioperative hemodynamic stability in elderly patients.Methods PubMed,Web of Science,the Cochrane Library,China National Knowledge Infrastructure(CNKI),and Wanfang Data were searched for randomized-controlled trials(RCTs)on the application of dexmedetomidine in maintaining perioperative hemodynamic stability in elderly patients from their inception to September,2021.The standardized mean differences(SMD)with 95%confidence interval(CI)were employed to analyze the data.The random-effect model was used for the potential clinical inconsistency.Results A total of 12 RCTs with 833 elderly patients(dexmedetomidine group,546 patients;control group,287 patients)were included.There was no significant increase in perioperative heart rate(HR),mean arterial pressure(MAP),and diastolic blood pressure(DBP)in the dexmedetomidine group before and during the operation.In addition,the variations of hemodynamic indexes including HR,MAP,SBP(systolic blood pressure),and DBP were significantly lower in the dexmedetomidine group compared with the control group(HR:SMD=-0.87,95%CI:-1.13 to-0.62;MAP:SMD=-1.12,95%CI:-1.60 to-0.63;SBP:SMD=-1.27,95%CI:-2.26 to-0.27;DBP:SMD=-0.96,95%CI:-1.33 to-0.59).Subgroup analysis found that with the prolongation of 1.0μg/kg dexmedetomidine infusion,the patient’s heart rate declined in a time-dependent way.Conclusion Dexmedetomidine provides more stable hemodynamics during perioperative period in elderly patients.However,further well-conducted trials are required to assess the effective and safer doses of dexmedetomidine in elderly patients.

Clinical Evaluation of a Vancomycin Dosage Strategy Based on a Serum Trough Concentration Model in Elderly Patients with Severe Pneumonia

Objective This study aimed to evaluate the clinical benefits of a vancomycin dosage strategy based on a serum trough concentration model in elderly patients.Methods This prospective single-center, open-label, randomized controlled trial categorized 66 elderly patients with severe pneumonia into study and control groups. The control group received vancomycin using a regimen decided by the attending physician. Meanwhile, the study group received individualized vancomycin therapy with a dosing strategy based on a serum trough concentration model. The primary endpoint was the proportion of patients with serum trough concentrations reaching the target values.The secondary endpoints were clinical response, vancomycin treatment duration, and vancomycinassociated acute kidney injury(VA-AKI) occurrence.Results All patients were at least 60 years old(median age = 81 years). The proportion of patients with target trough concentration achievement(≥ 15 mg/L) with the initial vancomycin regimen was significantly higher in the study group compared to the control group(75.8% vs. 42.4%, P = 0.006).Forty-five patients(68.2%) achieved clinical success, the median duration of vancomycin therapy was10.0 days, and VA-AKI occurred in eight patients(12.1%). However, there were no significant differences in these parameters between the two groups. The model for predicting vancomycin trough concentrations was upgraded to: serum trough concentration(mg/L) = 17.194-0.104 × creatinine clearance rate(mL/min) + 0.313 × vancomycin daily dose [mg/(kg·d)].Conclusion A vancomycin dosage strategy based on a serum trough concentration model can improve the proportion of patients achieving target trough concentrations in elderly patients with severe pneumonia.

Tear inflammation related indexes after cataract surgery in elderly patients with type 2 diabetes mellitus

BACKGROUND Quantitative studies on the changes in inflammation-related content in tears,especially the effect of diabetes,are lacking.In this study,we measured the preoperative and postoperative tear inflammatory mediator levels in cataract patients,focusing on the expression of inflammatory factors in postoperative cataracts in the diabetic,and investigated the effect of drugs on the control of postoperative inflammation.AIM To study the expression of inflammatory factors in elderly people with type 2 diabetes after cataract surgery.METHODS Patients with a mean age of 70.3±6.3 years were divided into group A(composed of elderly patients with cataracts and type 2 diabetes,n=20 eyes)and group B(patients with age-related cataract,n=20 eyes).Their tears were collected before each operation and on days 1 and 3,and weeks 1,2,3,and 4 post-surgery.Saline(150μL)was dropped into the conjunctival sac of the surgical eye,followed by oculogyration in four directions.The fluid in the conjunctival sac was extracted using a sterile syringe and stored in Eppendorf tubes at-80°C until measurement.The expression levels of matrix metalloproteinase-2(MMP-2),MMP-9,tissue inhibitor of metalloproteinase-1(TIMP-1),TIMP-2,interleukin-6(IL-6),and IL-20 in tear fluid were measured using enzyme-linked immunosorbent assays.RESULTS The postoperative expression levels of MMP-2,MMP-9,TIMP-2,IL-6,and IL-20 in group A were significantly higher than those in group B,whereas the concentration of TIMP-1 in group A remained lower than that in group B.The levels of MMP-2 and IL-6 in both groups continuously increased until the peak in the first postoperative week,and then gradually decreased over the next three weeks.Ultimately,MMP-2 declined to a lower level than that preoperatively at week 4,but IL-6 decreased to the same level as that preoperatively.The level of MMP-9 peaked in the first two weeks postoperative and then returned to the same level as 1-day post-operation.The concentration of TIMP-1 post-operation remained constant at a lower level than before surgery,and TIMP-2 Levels remained stable in both groups.IL-20 content started to increase in the third week after surgery.CONCLUSION Inflammatory factor levels in tears fluctuated before and post-operation,which indicated more severe postoperative inflammation in the first two weeks.

Peri-operative score for elderly patients with resectable hepatocellular carcinoma

BACKGROUND Liver resection is the mainstay for a curative treatment for patients with resectable hepatocellular carcinoma(HCC),also in elderly population.Despite this,the evaluation of patient condition,liver function and extent of disease remains a demanding process with the aim to reduce postoperative morbidity and mortality.AIM To identify new perioperative risk factors that could be associated with higher 90-and 180-d mortality in elderly patients eligible for liver resection for HCC considering traditional perioperative risk scores and to develop a risk score.METHODS A multicentric,retrospective study was performed by reviewing the medical records of patients aged 70 years or older who electively underwent liver resection for HCC;several independent variables correlated with death from all causes at 90 and 180 d were studied.The coefficients of Cox regression proportional-hazards model for sixmonth mortality were rounded to the nearest integer to assign risk factors'weights and derive the scoring algorithm.RESULTS Multivariate analysis found variables(American Society of Anesthesiology score,high rate of comorbidities,Mayo end stage liver disease score and size of biggest lesion)that had independent correlations with increased 90-and 180-d mortality.A clinical risk score was developed with survival profiles.CONCLUSION This score can aid in stratifying this population in order to assess who can benefit from surgical treatment in terms of postoperative mortality.

Impact of body mass index in elderly patients treated with laparoscopic liver resection for hepatocellular carcinoma

BACKGROUND The impact of obesity on surgical outcomes in elderly patients candidate for liver surgery is still debated.AIM To evaluate the impact of high body mass index(BMI)on perioperative and oncological outcome in elderly patients(>70 years old)treated with laparoscopic liver resection for hepatocellular carcinoma(HCC).METHODS Retrospective multicenter study including 224 elderly patients(>70 years old)operated by laparoscopy for HCC(196 with a BMI<30 and 28 with BMI≥30),observed from January 2009 to January 2019.RESULTS After propensity score matching,patients in two groups presented comparable results,in terms of operative time(median range:200 min vs 205 min,P=0.7 respectively in non-obese and obese patients),complications rate(22%vs 26%,P=1.0),length of hospital stay(median range:4.5 d vs 6.0 d,P=0.1).There are no significant differences in terms of short-and long-term postoperative results.CONCLUSION The present study showed that BMI did not impact perioperative and oncologic outcomes in elderly patients treated by laparoscopic resection for HCC.

Protective effect of sevoflurane on lung function of elderly chronic obstructive pulmonary disease patients undergoing total hip arthroplasty

BACKGROUND Chronic obstructive pulmonary disease(COPD)is a common respiratory disorder that affects the elderly population and increases the risk of postoperative pulmonary complications(PPCs)after major surgeries.Sevoflurane is a volatile anesthetic that has been shown to have anti-inflammatory and antioxidant properties and attenuate lung injury in animal models.AIM To evaluate the protective effect of sevoflurane on the lung function of elderly COPD patients undergoing total hip arthroplasty(THA).METHODS In this randomized controlled trial,we randomly assigned 120 elderly patients with COPD,who were scheduled for THA,to receive either sevoflurane(sevoflurane group)or propofol(propofol group)as the maintenance anesthetic.The primary outcome was the incidence of PPCs within seven days after surgery.The secondary outcomes were changes in the lung function parameters,inflammatory markers,oxidative stress markers,and postoperative pain scores.RESULTS The results showed that the incidence of PPCs was significantly lower in the sevoflurane group than in the propofol group(10%vs 25%,P=0.02).Furthermore,the decline in the forced expiratory volume in 1 s,forced vital capacity,and peak expiratory flow was significantly lesser in the sevoflurane group than in the propofol group at 24 h and 48 h after surgery(P<0.05).The interleukin-6,tumor necrosis factor-alpha,malondialdehyde,and 8-hydroxy-2α-deoxyguanosine levels were significantly lower in the sevoflurane group than in the propofol group at 24 h after surgery(P<0.05).The sevoflurane group showed significantly lower postoperative pain scores than the propofol group at 6 h,12 h,and 24 h after surgery(P<0.05).CONCLUSION Sevoflurane protects the lung function of elderly COPD patients undergoing THA under general anesthesia by reducing the incidence of PPCs,attenuating inflammatory and oxidative stress responses,and alleviating postoperative pain.

Rituximab combined with Bruton tyrosine kinase inhibitor to treat elderly diffuse large B-cell lymphoma patients: Two case reports

BACKGROUND Diffuse large B-cell lymphoma(DLBCL)is a common aggressive non-Hodgkin's lymphoma(NHL),accounting for 30%-40%of adult NHLs.This report aims to explore the efficacy and safety of rituximab combined with Bruton tyrosine kinase inhibitors(BTKis)in the treatment of elderly patients with DLBCL.CASE SUMMARY The clinical data of two elderly patients with DLBCL who received rituximab combined with BTKi in our hospital were retrospectively analyzed,and the literature was reviewed.The patients were treated with chemotherapy using the R-miniCHOP regimen for two courses.Then,they received rituximab in combination with BTKi.CONCLUSION The treatment experience in these cases demonstrates the potential efficacy of rituximab combined with BTKi to treat elderly DLBCL patients,thus providing a new treatment strategy.

Effects of health concept model-based detailed behavioral care on mood and quality of life in elderly patients with chronic heart failure

BACKGROUND With the intensification of social aging,the susceptibility of the elderly population to diseases has attracted increasing attention,especially chronic heart failure(CHF)that accounts for a large proportion of the elderly.AIM To evaluate the application value of health concept model-based detailed behavioral care in elderly patients with CHF.METHODS This study recruited 116 elderly CHF patients admitted from October 2018 to October 2020 and grouped them according to the nursing care that they received.The elderly patients who underwent health concept model-based detailed behavioral care were included in a study group(SG;n=62),and those who underwent routine detailed behavioral nursing intervention were included as a control group(CG;n=54).Patients’negative emotions(NEs),quality of life(QoL),and nutritional status were assessed using the self-rating anxiety/depression scale(SAS/SDS),the Minnesota Living with Heart Failure Questionnaire(MLHFQ),and the Modified Quantitative Subjective Global Assessment(MQSGA)of nutrition,respectively.Differences in rehabilitation efficiency,NEs,cardiac function(CF)indexes,nutritional status,QoL,and nursing satisfaction were comparatively analyzed.RESULTS A higher response rate was recorded in the SG vs the CG after intervention(P<0.05).After care,the left ventricular ejection fraction was higher while the left ventricular end-diastolic dimension and left ventricular end systolic diameter were lower in the SG compared with the CG(P<0.05).The post-intervention SAS and SDS scores,as well as MQSGA and MLHFQ scores,were also lower in the SG(P<0.05).The SG was also superior to the CG in the overall nursing satisfaction rate(P<0.05).CONCLUSION Health concept model-based detailed behavioral care has high application value in the nursing care of elderly CHF patients,and it can not only effectively enhance rehabilitation efficiency,but also mitigate patients’NEs and improve their CF and QoL.

Analysis of clinical characteristics and risk factors between elderly patients with severe and nonsevere Omicron variant infection

BACKGROUND Coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has led to millions of confirmed cases and deaths worldwide.Elderly patients are at high risk of developing and dying from COVID-19 due to advanced age,decreased immune function,intense inflammatory response,and comorbidities.Shanghai has experienced a wave of infection with Omicron,a new variant of SARS-CoV-2,since March 2022.There is a pressing need to identify clinical features and risk factors for disease progression among elderly patients with Omicron infection to provide solid evidence for clinical policy-makers,public health officials,researchers,and the general public.AIM To investigate clinical characteristic differences and risk factors between elderly patients with severe and nonsevere Omicron SARS-CoV-2 variant infection.METHODS A total of 328 elderly patients with COVID-19 admitted to the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from April 2022 to June 2022 were enrolled and divided into a severe group(82 patients)and a nonsevere group(246 patients)according to the diagnosis and treatment protocol of COVID-19(version 7).The clinical data and laboratory results of both groups were collected and compared.A chi-square test,t test,Mann-Whitney U test,hierarchical log-rank test,univariate and multivariate logistic regression,and hierarchical analyses were used to determine significant differences.RESULTS The severe group was older(84 vs 74 years,P<0.001),included more males(57.3%vs 43.9%,P=0.037),had a lower vaccination rate(P<0.001),and had a higher proportion of comorbidities,including chronic respiratory disease(P=0.001),cerebral infarction(P<0.001),chronic kidney disease(P=0.002),and neurodegenerative disease(P<0.001),than the nonsevere group.In addition,severe disease patients had a higher inflammatory index(P<0.001),greater need for symptomatic treatment(P<0.001),longer hospital stay(P=0.011),extended viral shedding time(P=0.014),and higher mortality than nonsevere disease patients(P<0.001).No difference was observed in the application of Paxlovid in the severe and nonsevere groups(P=0.817).Oxygen saturation,cerebral infarction,and D-dimer were predictive factors for developing severe disease in patients with COVID-19,with D-dimer having an excellent role(area under the curve:90.1%,95%CI:86.1-94.0%).In addition,D-dimer was a risk factor for developing severe COVID-19 according to multivariate stratified analysis.CONCLUSION The clinical course of severe COVID-19 is complex,with a higher need for symptomatic treatment.D-dimer is a suitable biomarker for identifying patients at risk for developing severe COVID-19.

Addressing Nursing Safety Hazards and Mitigation Strategies for Elderly Endocrinology Patients in Hospital Care

Objective:To investigate the safety hazards in nursing and explore mitigation strategies for elderly patients in the endocrinology department.Methods:A total of 240 bedridden elderly patients from February 2021 to January 2023 were recruited and divided into two groups using the random number table method.The control group(n=120)received conventional nursing care,and the observation group(n=120)received personalized nursing care.Patients’quality of life,the incidence rate of pressure sores,and patient satisfaction with nursing care were observed and analyzed.Results:The incidence of pressure ulcers in the observation group was significantly lower at 17.50%compared to 30.00%in the control group(P<0.05).Quality of life in the observation group was significantly higher than that in the control group(P<0.05).The satisfaction rate in the observation group was significantly higher at 93.33%compared to 84.17%in the control group(P<0.05).Conclusion:These findings emphasize that only through the implementation of scientific and rational nursing measures can effectively reduce nursing risks,enhance therapeutic outcomes,and improve the quality of life for elderly patients.

Fixation of Calcaneal Tuberosity Beavis II Fracture in Elderly Patients Using Locking Plate Combined with Tension Screw

Background:Calcaneus is the largest bone of foot and the main load-bearing structure of heel.The incidence of simple calcaneal tubercle avulsion fracture is low,accounting for about 1%to 3%of all calcaneal fractures.Beavis II fracture has large bone fracture,obvious displacement,obvious soft tissue irritation,and often leads to skin necrosis.It needs surgical treatment,reduction and fixation as soon as possible.Although open reduction and tension screw internal fixation is used for Beavis II calcaneal tubercle fracture,but the failure rate is more common.Methods:This study retrospectively analyzed the surgical treatment of calcaneal tubercle Beavis II fracture over 55 years old in our hospital from January 2013 to January 2019.The patients were treated with tension screw combined with locking plate,and followed up and analyzed.Results:12 patients in this group were followed up for 12 to 36 months(mean 20 months).After operation,the fracture healed smoothly in all patients,the healing time was 8 to 12 weeks(mean 10.7 weeks),and there were no complications such as poor incision healing,fracture displacement,internal fixation loosening,fracture and so on.When the patients were followed up 18 weeks after operation,the AOFAS score was 47 to 100,with an average of 91.1,of which 8 cases were excellent,3 good and 1 poor,with an excellent and good rate of 91.7%.Conclusion:Our hospital has been treated with tension screw combined with locking plate,fixed firmly,can early functional exercise,achieved good results.

PCI compared with medical therapy in elderly patients with chronic symptomatic coronary artery disease

Objective The aim of this study was to assess quality of results of elderly patients with coronary disease after medical or revascularisation therapy. Methods In this study, we enrolled 103 patients aged 75 years or older with chronic angina in which 47 patients were assigned coronary angiography and revascularisation and 56 patients with optimised medical therapy. The primary endpoint was quality of life after 6 months, as assessed by questionnaire and the presence of major adverse cardiac events (death, non fatal myocardial infarction, or hospital admission for acute coronary syndrome with or without the need for revascularisation). Results After 6 months follow up, angina severity decreased and measures of quality of life increased in both treatment groups( P <0.05 ); however, these improvements were significantly greater after revascularisation( P <0.01 ). Major adverse cardiac events occurred in 30 ( 53.6% ) of patients in the medical group and 9 ( 19.1% ) in the invasive group ( P <0.01 ).Conclusions Patients aged 75 years or older with angina benefit more from revascularisation than from optimised medical therapy in terms of symptom relief and quality of life. Therefore, these patients should be offered invasive assessment despite their high risk profile followed by revascularisation if feasible.

Chronic Subdural Hematoma Associated with an Arachnoid Cyst in Elderly, an Intraoperative Finding after Re-Bleeding: Case Report

Intracranial arachnoid cysts (AC) are believed to be congenital and chronic subdural hematomas tend to occur in elderly patients with a history of mild head injury. The association between these two entities sporadically occur in relatively young patients but rare in elderly patients. We report a 65-year-old man who presented with headache and dizziness of 2 months’ duration with a history of head injury. Brain computed tomography (CT) a CSDH in right side and a hygroma in left side. After first operation with burr holes in both sides, the patient underwent an early recurrence of acute subdural hematoma in the right side. The evacuation of this hematoma by a craniotomy allowed seeing an AC that we resected partially with complete recovery of the patient. The association CSDH/AC is rare and possible in elderly patients and there is no consensus on treatment.

Horizontal Inferior Patellar Dislocation in an Elderly Patient: A Case Report and Review of Literature

Intra-articular patellar dislocation due to acute trauma is considered a rare presentation and is less commonly encountered in practice than extra-articular patellar dislocation. This case study presents a rare type 2 inferior dislocation of the patella in an elderly patient which was successfully reduced and managed non-operatively.

Rockall score in predicting outcomes of elderly patients with acute upper gastrointestinal bleeding

AIM: To validate the clinical Rockall score in predicting outcomes (rebleeding, surgery and mortality) in elderly patients with acute upper gastrointestinal bleeding (AUGIB). METHODS: A retrospective analysis was undertaken in 341 patients admitted to the emergency room and Intensive Care Unit of Xuanwu Hospital of Capital Medical University with non-variceal upper gastrointestinal bleeding. The Rockall scores were calculated, and the association between clinical Rockall scores and patient outcomes (rebleeding, surgery and mortality) was assessed. Based on the Rockall scores, patients were divided into three risk categories: low risk ≤ 3, moderate risk 3-4, high risk ≥ 4, and the percentages of rebleeding/death/surgery in each risk category were compared. The area under the receiver operating characteristic (ROC) curve was calculated to assess the validity of the Rockall system in predicting rebleeding, surgery and mortality of patients with AUGIB. RESULTS: A positive linear correlation between clinical Rockall scores and patient outcomes in terms of rebleeding, surgery and mortality was observed (r =0.962, 0.955 and 0.946, respectively, P = 0.001). High clinical Rockall scores > 3 were associated with adverse outcomes (rebleeding, surgery and death). There was a significant correlation between high Rockall scores and the occurrence of rebleeding, surgery and mortality in the entire patient population (χ 2 = 49.29, 23.10 and 27.64, respectively, P = 0.001). For rebleeding, the area under the ROC curve was 0.788 (95%CI: 0.726-0.849, P = 0.001); For surgery, the area under the ROC curve was 0.752 (95%CI: 0.679-0.825, P = 0.001) and for mortality, the area under the ROC curve was 0.787 (95%CI: 0.716-0.859, P = 0.001). CONCLUSION: The Rockall score is clinically useful, rapid and accurate in predicting rebleeding, surgery and mortality outcomes in elderly patients with AUGIB.

Considerations of elderly factors to manage the complication of liver cirrhosis in elderly patients

The aging of the organ function causes sensitivity to the disease progression and need careful consideration for the medical treatment. With the increase of aging population, the opportunity to provide medical treatment for people in very old age is rapidly increasing therefore, the understanding of the various physiological changes of cellular function, size and function of organs are essential for the decision of therapeutic options. Among the various chronic conditions seen in elderly people, we have focused on liver cirrhosis, since despite specific therapeutic options for many of liver diseases including direct acting antivirals for hepatitis C virus, nucleoside analogs for hepatitis B, and corticosteroids for autoimmune hepatitis, there is currently no standard therapy to treat liver cirrhosis, which is the final stage of these liver diseases. Therefore,management of the various symptoms of liver cirrhosis is essential, and agingrelated parameters must be considered in the decision making for therapeutic strategies and dosage of the available medicine. In this mini-review, we have summarized the therapeutic options to manage various symptoms of liver cirrhosis, carefully considering the physiological changes of various organs associated with aging.