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Resumen El mieloma múltiple es una neoplasia del paciente mayor con una edad media de diagnóstico de 70 años. Los pacientes de edad avanzada con mieloma de alto riesgo genético están poco representados en los estudios clínicos y son un grupo difícil de tratar, con una sobrevida menor a dos años. La edad trae consigo comorbilidades y fragilidad que determinan tolerancia pobre a terapias y mayor mortalidad, obligando a usar tratamientos no intensivos, con el objetivo de controlar la enfermedad y mantener la calidad de vida. En pacientes con mielomas de alto riesgo genético, en cambio, se busca lograr respuestas profundas con el uso de tripletes para superar el efecto adverso de la citogenética. Es así como el tratamiento del mieloma de alto riesgo a edades avanzadas implica requerir tratamientos efectivos en pacientes frágiles y con mala tolerancia a éstos. Se presenta el caso de una paciente de 84 años con mieloma de alto riesgo genético, determinado por la amplificación de 1q21, que recibe tratamientos sucesivos basados en lenalidomida, bortezomib, daratumumab y carfilzomib, lográndose mantener la enfermedad controlada por más de seis años. Este caso documenta que, en pacientes añosos con enfermedad de alto riesgo genético, un tratamiento continuado con drogas efectivas, un ajuste adecuado de dosis y tratamiento de soporte pueden mantener la enfermedad controlada con mínima toxicidad y prolongar la sobrevida del paciente adulto mayor.
Abstract Multiple myeloma is a neoplasm that primarily affects elderly patients, with an average age of diagnosis of 70 years. Elderly patients with high-risk genetic myeloma are underrepresented in clinical studies and pose a challenging group to treat, with a median survival of less than two years. Advanced age brings comorbidities and frailty, which result in poor tolerance to therapies and increased mortality, necessitating the use of less intensive treatments aimed at disease control and maintaining quality of life. In contrast, for high-risk myeloma, deep responses are sought through the use of triplets to overcome the adverse effects of cytogenetics. Thus, treating high-risk myeloma in elderly patients presents the challenge of requiring effective treatments in frail individuals with poor tolerance. We present the case of an 84-year-old patient with high-risk genetic myeloma determined by the amplification of 1q21, who received successive treatments based on lenalidomide, bortezomib, daratumumab, and carfilzomib, successfully maintaining disease control for over six years. This case documents that in elderly patients with high-risk disease, continuous treatment with effective drugs, appropriate dosage adjustments and supportive care can keep the disease under control with minimal toxicity and prolong the survival of the elderly patient.
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Hypokalemic paralysis is a rare neuromuscular disorder characterized by painless muscle weakness resulting from low potassium levels, most commonly presenting during adolescence. In this case report, we detail the presentation and management of an 80-year-old female who experienced sudden onset bilateral limb weakness. Initial clinical assessment revealed the absence of reflexes and hypotonia in all four limbs without any gastrointestinal or neurological symptoms. Comprehensive diagnostic evaluation identified severe iron deficiency anemia and an unusual history of clay ingestion due to pica as the underlying causes of her hypokalemic paralysis. Treatment included intravenous and oral potassium supplementation, as well as packed cell volume transfusions, leading to a significant improvement in her symptoms and normalization of her potassium levels. This case highlights the need to consider atypical etiologies, such as pica-induced clay ingestion, in the differential diagnosis of hypokalemic paralysis, particularly in elderly patients with nutritional deficiencies. Early recognition and appropriate management are critical for favourable outcomes.
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Background: In India, aging population is increasing every year. So, healthcare industry needs to set up a geriatric unit soon. Development of geriatrics and old-age care systems in India will make elderly people independent and improve their lifestyle, life expectancy, and quality of life while decreasing the cost of care. This study looks at the views of patients who are 60 years or older, as well as need for a full-fledged geriatric unit in a tertiary care hospital. Methods: This study used questionnaires to get information from patients about the need for a geriatric care service in the chosen tertiary care teaching hospital. The study was conducted between March 2022 to July 2022 Results: Over 96% of the patients opined that elderly patients require a separate health care setup from the regular health care system. The study showed that 69.9% of the patient respondents opined that they require an attendant each time they visit a hospital. Also, 51.6% of the patients did not go to their doctor's appointments because they needed someone to accompany them to the hospital. Conclusions: A study shows that older people rely on family members to check out healthcare facilities. If a new geriatric unit has the latest facilities, 96.8% of the patients will take advantage of them. Hence, a well-established geriatric department in the selected hospital is the need of the hour.
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Background: The present study aimed to compare outcomes between geriatric patients treated with cementless bipolar hip arthroplasty (BHA) and proximal femoral nail (PFN) for intertrochanteric femur fractures, focusing on postoperative complications, reoperation rates, implant-related issues, and functional outcomes. Methods: The present study took place at PRM medical college, Baripada for a period of 4 years and employed a prospective design with 76 individuals with femoral shaft fractures who underwent surgical treatment, wherein 40 were treated using cementless BHA and 36 with PFN. Evaluation included the HHS at the last follow-up, alongside recorded blood transfusion rates and surgery duration, statistically compared between the two groups. Results: The study involved elderly patients with intertrochanteric femur fractures (average age: 82.9 years). BHA and PFN groups had differing average ages (81.4 and 83.9 years, respectively). Follow-up durations were 18.6 months overall, 23.8 months for BHA, and 13.1 months for PFN. PFN showed advantages in surgery duration and blood transfusion rates. Adverse effects in BHA included 4 epidermal infections, while PFN had 2 epidermal infections and 2 instances of implant malfunction, resulting in extraction. PFN demonstrated a 5.5% cut-out rate. Conclusions: The study compares the outcomes of elderly patients with femoral shaft fractures treated with cementless BHA and PFN. The results indicate that PFN presents advantages over BHA in terms of shorter surgery duration and reduced blood transfusion rates. However, further research and extended review are warranted to draw definitive results about the superiority of either approach.
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Reminiscence therapy (RT) attenuates psychological disorders in cancer patients. This study aimed to evaluate the effect of RT on anxiety, depression, spiritual well-being, and quality of life in elderly patients with unresectable, metastatic gastrointestinal cancer. A total of 222 elderly patients with unresectable, metastatic gastrointestinal cancer were randomized into RT group (RT plus usual care, n=112) or control group (usual care, n=110) with a 6-month intervention. Hospital Anxiety and Depression Scale for Anxiety (HADS-A) and Depression (HADS-D), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), and Quality of Life Questionnaire-Core 30 (QLQ-C30) were evaluated at month (M)0, M1, M3, and M6. Concerning the primary outcome, HADS-A score at M6 decreased in the RT group compared to the control group (P=0.005). As to secondary outcomes, the RT group showed decreased HADS-A scores at M3, anxiety rate at M3, HADS-D scores at M3 and M6, depression rate at M6, as well as greater FACIT-Sp scores at M1, M3, and M6 vs the control group (all P<0.050). Additionally, QLQ-C30 global health score was elevated at M1 (P=0.046) and M6 (P=0.005), functions score was greater at M6 (P=0.038), and symptoms score was lower at M3 (P=0.019) in the RT group than in the control group. Subgroup analysis revealed that the addition of RT was more effective for patients with anxiety or depression at baseline. In summary, RT alleviated anxiety and depression, and improved the spiritual well-being and quality of life within 6 months in elderly patients with unresectable, metastatic gastrointestinal cancer.
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Objective To investigate the onset situation of sarcopenia in elderly patients with type 2 di-abetes mellitus(T2DM),and to analyze the influence factors of fall risk and the relationship between the com-plicating muscle function reduction and the fall risk.Methods A total of 512 cases of T2DM aged ≥60 years old in this hospital from January 2020 to December 2022 served as the study subjects.The grip strength(HS)was tested by the CAMRY-EH101 grip tester,the walking speed(GS)was measured by the stopwatch and tape measure,the muscle content was analyzed and determined by bioelectrical impedance.The skeletal muscle mass index(SMI)was calculated.Sarcopenia was grouped by the AWGS2019 standard,the Morse fall Risk Prediction Scale was used to evaluate the fall risk,and the influencing factors of fall risk were analyzed by bi-nary logistic regression.Results The detection rate of sarcopenia among the study subjects was 19.92%,and 399 patients(77.93%)had the fall risk.Whether having sarcopenia or the severity of sarcopenia had no influ-ence on the fall risk(P>0.05).Among the patients without sarcopenia,the fall risk in the HS,GS and SMI decrease group was increased compared with the normal group(P<0.001).The results of the multi-factor a-nalysis showed that the 7 types of variables such as gender,BMI,blood glucose,IL-6,T2DM retinopathy,T2DM pe-ripheral neuropathy and T2DM vascular disease were the influencing factors of fall risk(P<0.05).Conclusion Eld-erly patients with T2DM have a higher fall risk,and T2DM combined with decreased muscle function could aggravate the fall risk,but T2DM combined with sarcopenia has no significant effect on the fall risk.
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Objective To investigate the value of peripheral blood soluble interleukin-2 receptor(sIL-2R),CD4+lymphocyte percentage/CD8+lymphocyte percentage ratio(hereinafter referred to as CD4+/CD8+)and tumor necrosis factor-α(TNF-α)in evaluating the efficacy of chemotherapy in elderly patients with newly treated active pulmonary tuberculosis.Methods A total of 102 elderly patients with newly treated active tu-berculosis admitted to the hospital from December 2019 to December 2022 were enrolled in the study as the observation group,and 102 healthy people aged 60 and older who underwent physical examination in the hos-pital during the same period were enrolled as the control group.The levels of sIL-2R,TNF-α and CD4+/CD8+in peripheral blood were compared between the two groups,and the correlations between sIL-2R,TNF-α and CD4+/CD8+were analyzed.The observation group was treated with 2HRZE/4HR anti-tuberculosis treatment regimen.The levels of sIL-2R,TNF-α and CD4+/CD8+in peripheral blood of patients with different efficacy before treatment,1 month and 6 months after treatment in the observation group were compared.The correla-tion between sIL-2R,CD4+/CD8+,TNF-α levels and therapeutic effect was analyzed.The receiver operating characteristic(ROC)curve was used to analyze the efficacy of indicators in evaluating the efficacy of chemo-therapy in elderly patients.Results The levels of sIL-2R and TNF-α in the observation group were higher than those in the control group,while CD4+/CD8+was lower than that in the control group,and the differ-ences were statistically significant(P<0.05).In the observation group,sIL-2R and TNF-α were negatively correlated with CD4+/CD8+(P<0.05),sIL-2R was positively correlated with TNF-α(P<0.05).After 1 month and 6 months of treatment,the levels of sIL-2R and TNF-α in patients with apparent efficacy were low-er than those in patients with efficacy,and the latter were lower than those in patients with no effect,while the CD4+/CD8+in patients with apparent efficacy was higher than that in patients with efficacy,and the latter was higher than that in patients with no efficacy,and the differences were statistically significant(P<0.05).The levels of sIL-2R and TNF-α were negatively correlated with the efficacy(P<0.05),and CD4+/CD8+was positively correlated with the efficacy(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of sIL-2R,CD4+/CD8+,and TNF-α used in combination to assess efficacy was significantly greater than the AUCs of the single indicators used in the assessment at each time point of treatment(P<0.05),and the AUC of the combination of the indicators was greater after 6 months of treatment than after 1 month of treatment(P<0.05).Conclusion The levels of sIL-2R,CD4+/CD8+and TNF-α are closely related to the ef-ficacy of chemotherapy in elderly patients with newly treated active pulmonary tuberculosis,and the combina-tion of the above indicators has certain reference value in evaluating the efficacy of chemotherapy in patients.
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Objective To analyze risk factors for perioperative blood transfusion in elderly patients undergoing uni-lateral primary total hip arthroplasty and develop a prediction model.Methods The study retrospectively collected 467 elderly patients receiving unilateral primary total hip arthroplasty between January 2013 and October 2021 at Peking Union Medical College Hospital.The 70%of the data were used as the training set and the 30%of the data were used as the testing set.Patients were divided into the transfusion and no-transfusion groups based on the presence or absence of perioperative blood transfusion.Univariate analysis and multivariable logistic regression were conducted to analyze patient demographic characteristics,surgical information,and preoperative laboratory tests for identifying risk factors.Clinical experience was combined to establish a prediction model and draw the nomogram.The receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the model in the tes-ting set.Results A total of 91 patients(19.5%)received perioperative blood transfusion.Multivariable logistic re-gression suggested the history of coronary artery disease,prolonged operation time,and lower preoperative hemoglo-bin were risk factors for perioperative blood transfusion(P<0.05).The prediction model was constructed based on the results of statistical analysis and clinical experience,including the history of coronary artery disease,operation time,preoperative hemoglobin,age,and American Society of Anesthesiologists(ASA)physical status>Ⅱ.The area under the receiver operating characteristic curve(AUC)of the model was 0.809.Conclusions The prediction model for perioperative blood transfusion in elderly patients undergoing unilateral total hip arthroplasty had a good performance and could assist in clinical practice.
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Objective To investigate the effects of the laparoscopic surgery and open surgery on the postoperative intestinal function recovery time in elderly patients with colorectal cancer(CRC).Methods 66 elderly patients with CRC and treated in the 2nd People's Hospital of Kunming from January 2021to July 2022 were chosen and divided into the control group(n = 33)and the study group(n = 33)according to different operation ways.And the postoperative bowel function recovery time,radical,complications and surgical index were compared between the two groups.Results The recovery time of intestinal function in the study group was significantly shorter than that in the control group(P<0.05),but there was no significant difference in radical indicators between the two groups(P>0.05).The incidence of complications in the study group was lower than that in the control group,and the difference was statistically significant(P<0.05).The operation time of the study group was longer than that of the control group and there was the statistically significant difference(P<0.05),while the bleeding was less than that of the control group and there was the statistically significant difference(P<0.05).Conclusion Compared with the open surgery,laparoscopic surgery can more effectively shorten the recovery time of postoperative intestinal function,reduce the incidence of complications and intraoperative blood loss in elderly patients with CRC.Although there is no significant difference between two kinds of operation mode in terms of radical,it should be considered when it is applied in the specific operation time and other factors.
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Objective To explore the comparative application of phase and diaphragmatic navigation in three-dimensional magnetic resonance cholangiopancreatography(3D-MRCP)thin-layer scanning in elderly patients.Methods A total of 180 elderly patients were scanned by phase and diaphragmatic navigation via Siemens Aera1.5T superconducting MR scanner.The acquired images were reconstructed by 3D reconstruction.The anatomical structure,image quality and disease diagnosis were compared between the phase and diaphragmatic navigation groups.Results In liver of anatomy,the liver of primary bile duct,the superior,middle and inferior extrahepatic bile duct and the gallbladder could be well displayed,and the difference was not statistically significant between the two groups(P>0.05).The display of pancreatic duct and the liver of secondary bile duct of diaphragmatic navigation was significantly better than those of phase navigation(P<0.05).In terms of image quality,the excellent rate of diaphragmatic navigation was significantly higher than that of phase navigation,and the difference was statistically significant(P<0.05).There were no statistically significant differences in the detection rate of pancreatobiliary system diseases,the diagnostic rate of cholelithiasis,common bile duct stones,common bile duct dilatation and pancreatic duct dilatation between the two groups(P>0.05).Conclusion Diaphragmatic navigation is signifi-cantly better than phase navigation in the display of the anatomical structure of the pancreatic duct,the liver of secondary bile duct,and the excellent rate of image quality.Diaphragmatic navigation is more suitable for thin-layer 3D-MRCP scanning in elderly patients.
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Objective:To study the effects of low-dose dexmedetomidine via nasal spray on preoperative anxiety and tracheal intuba-tion induced stress response in elderly patients with maxillofacial surgery using heart rate variability(HRV).Methods:60 elderly pa-tients underwent maxillofacial surgery were randomly divided into the dexmedetomidine group(group D)and the control group(group C).Patients in the group D were treated with nasal spray of dexmedetomidine at 45 min preoperatively.Those in the group C were giv-en the same dose of normal saline spray at the same time.All patients were given intravenous combined with inhalation general anes-thesia.The hemodynamics,HRV index,sedation score and BIS value of the 2 groups of patients were compared at 3 time points,be-fore operation(T0),entrance(T1)and tracheal intubation(T2)respectively.Results:At T1,the average score of Ramsay in group D and group C was 2.8±0.7 and 1.1±0.39,BIS 87.3±6.1 and 97.4±0.5,SD1 20.9±7.0 and 15.4±5.4,SDNN 30.9±6.6 and 37.1±7.0,LF/HF 1.3±0.3 and 2.6±0.4,respectively(P<O.01).At T2,the average score of SD1 in group D and group C was 10.4±3.5 and 7.7±3.1,SDNN 59.2±6.5 and 70.1±7.1,LF/HF 5.l±0.5 and 7.5±0.5,respectively(P<0.01).Conclusion:Low-dose dexmedetomidine nasal spray can effectively relieve the preoperative anxiety of elderly patients in maxillofacial surgery and reduce the stress response of tracheal intubation.
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Objective To investigate the effect of ultrasound-guided anterior quadratus lumborum block at lateral supra-arcuate ligament on postoperative analgesia and inflammation response in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy.Methods A total of 60 elderly patients who had undergone robot-assisted laparoscopic radical prostatectomy from June 2022 to June 2023 were randomly divided into a group of ultra-sound-guided anterior quadratus lumborum block at lateral supra-arcuate ligament combined with general anesthesia(observation group,n = 30)and a general anesthesia group(control group,n = 30).Both groups received patient-controlled intravenous analgesia after surgery.The first compression time of an analgesic pump and the numbers of effective compression and remedial analgesia were recorded.The VAS scores at postsurgical hours 2,12,24,and 48 during rest and coughing were recorded.Interleukin-6(IL-6)and systemic immunoinflammatory index(SII)at one day before surgery and two hours,one day and three days after surgery were recorded.Anal exhaust time,length of postoperative hospital stay and occurrence of adverse reactions were recorded.Results The observation group,as compared with the control group,had significantly longer first compression time of an analgesic pump and had fewer numbers of effective compressions and remedial analgesic administrations(P<0.05).The VAS scores during rest and coughing in the observation group were lower than those in the control group at postsurgical hours 2,12,24,and 48(P<0.05).As compared with one day before surgery,both IL-6 and SII in the two groups increased at 2 hours,1,and 3 days after surgery,but the changes in the observation group were lower than those in the control group(P<0.05).As compared with the control group,the observation group had shorter anal exhaust time and length of postoperative hospital stay,and a lower incidence of adverse reactions(P<0.05).Conclusions Ultrasound-guided anterior quadratus lumborum block at lateral supra-arcuate ligament can provide better postoperative analgesia,reduce inflammatory response and accelerate postoperative recovery in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy.
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Elderly breast cancer patients have different characteristics from young breast cancer patients,and their treat-ment faces many challenges.The treatment for elderly patients with breast cancer is often based on retrospective studies or evi-dence of general population lacks Class I clinical evidence.This article summarized the relevant clinical studies of advanced breast cancer with different molecular subtypes,explored the optional treatments and development directions for advanced elderly breast cancer,and provided reference for clinicians.
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Patients with severe tumors do not refer to the patients with end-stage tumors,but rather to the patients with a performance status(PS)score between 2 and 4 in certain stages due to various reasons,such as acute or chronic comorbidities,tumor itself,or treatment-related adverse events.To these patients,there is a high probability of achieving survival benefit and/or improvement in PS scores after synergistic management of available life-support technologies and anti-tumor therapies based on dynamic and precise testing.Elderly patients with tumors frequently present with one or more chronic illnesses and have poor toler-ance and compliance to treatment.Moreover,their treatment regimens often lack high-quality clinical evidence,making them more susceptible to developing severe tumors.The management of severe tumors in the elderly is based on three basic diagnosis and treatment technologies:dynamic and precise detection,powerful life support technologies,and skillful application of current anti-tumor treatments.In specific clinical practice,the following 7 flexible and individualized treatment strategies should be adopted for different tumor types:1.concurrent management of cancer and comorbidities,2.upgrading and downgrading of anti-tumor drugs based on PS score,3.dynamic accurate detection,4.skillful combinations for increasing efficacy and reducing toxicity,5.complete overview,paying equal attention to systemic therapy and local therapy,6.safety first in medication for the elderly,7.multi-discipli-nary participation,individualized and comprehensive treatment.This article introduced the concept of severe tumors in the elderly and the associated management strategies,to increase awareness and provide feasible guidance for clinical practice.
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Objective To investigate the effect of rimimazolam tosylate on hemodynamics during the induction of general anesthesia in elderly patients.Methods A total of 90 elderly patients who received non-cardiac surgery under tracheal intubation general anesthesia in our hospital were selected,and randomly divided into the remimazolam tosylate group(group R)and the etomidate group(group E).During anesthesia induction,patients in the group R were given 0.3 mg/kg of remimazolam tosylate,and patients in the group E were given 0.3 mg/kg of etomidate.The heart rate(HR),mean arterial pressure(MAP),and bispectral index(BIS)before the induction of anesthesia(T0),after the induction of anesthesia(T1),and after tracheal intubation(T2)of patients in the two groups were compared.The induction time,extubation time,Ramsay sedation score 5 minutes after extubation,time out of the postanesthesia care unit(PACU),operation time,anesthesia time and incidence of adverse reactions in the two groups were counted.Results There was no significant difference in the MAP,HR or BIS of patients at T0 between the two groups(P>0.05);the MAP of patients at T1 and T2 in the group R were higher than those in the group E(P<0.05),and the HR of patients at T2 was lower than that in the group E(P<0.05).Compared with T0,the HR,MAP and BIS of patients at T1 and T2 in the group R were decreased;the MAP and BIS of patients at T1 and T2 in the group E were decreased,HR of patients was decreased at T1 and increased at T2,with statistically significant differences(P<0.05).The induction time and extubation time of patients in the group R were shorter than those in the group E(P<0.05).There was no significant difference in the Ramsay sedation score,time out of the PACU,operation time oranesthesia time of patients between the two groups(P>0.05).The incidences of myoclonus and hypotension of patients in the group E were higher than those in the group R,and the total incidence of adverse reactions in the group E was higher than that in the group R,with statistically significant differences(P<0.05).Conclusion Compared to etomidate,remazolam tosylate is more stable in inducing hemodynamics and has fewer adverse reactions in elderly patients under general anesthesia.
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Objective To investigate the relevant risk factors for endoscopic electrocoagulation hemostasis in elderly patients with acute epistaxis,and establish and validate a nomogram prediction model to facilitate early selection of appropriate hemostasis methods in clinical practice.Methods Clinical data of 228 elderly patients with unilateral acute epistaxis from January 2018 to December 2022 were collected.There were two groups,the electrocoagulation group(n = 112)and the conservative packing group(n = 116),based on whether they received endoscopic electrocoagulation hemostasis.Analysis was performed to explore the independent risk factors for requiring endoscopic electrocoagulation hemostasis.A nomogram prediction model was established based on the multivariate results,and receiver operator characteristic curve(ROC curve),calibration curve and clinical decision curve analysis(DCA)were used to evaluate the predictive performance and consistency of the model.Results According to the research results,the univariate analysis showed that age,hypertension,cardiovascular disease,anticoagulant use,and bleeding site were associated with endoscopic electrocoagulation hemostasis(P<0.05).The multivariate binary Logistic regression analysis revealed that older age,the presence of hypertension,long-term use of anticoagulants,and bleeding sites located in the posterior nasal region or unknown location were associated with a higher likelihood of undergoing endoscopic electrocoagulation hemostasis(P<0.05).Based on these independent risk factors,a nomogram model for predicting endoscopic electrocoagulation hemostasis for acute epistaxis in elderly patients was established,the area under the curve(AUC)was 0.856(95%CI:0.805~0.907).The calibration curve and DCA showed that the use of the nomogram model could benefit patients over a wide range of diagnostic threshold probabilities.Conclusion A nomogram model based on age,hypertension,anticoagulant use,and bleeding site to predict the risk of endoscopic electrocoagulation hemostasis in elderly patients with acute epistaxis has a good predicted performance.
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Objective To identify and analyze the key factors affecting the use behavior of elderly patients with smart medical services by taking the smart medical system of a top-three hospital as an example,so as to provide a basis for promoting the use of smart medical services for elderly patients and the age-appropriate transformation of smart medical services.Methods The factors influencing the use behavior of elderly patients with smart medical services were analyzed,and correlation analysis of factors influencing the use behaviour of elderly patients with smart medical services were analyzed by DEMATEL method.Results The centrality and causation of all influencing factors were calculated,and the key influencing factors affecting the use behavior of elderly patients with smart medical services were identified.Among them,the main factors of reason degree are the hospital's willingness to adapt to aging transformation,the influence of key population and relevant national policy support,and the main factor of center degree is the perceived cost of patients.Conclusion The perceived cost of elderly patients can be reduced by improving the smart medical service,enhancing the health information literacy of elderly patients and giving full play to the social support effect,so as to promote the use behavior of elderly patients'smart medical services.
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Frailty is a complex age-related clinical condition characterized by a decline in physiological capacity across several organ systems, with a resultant increased susceptibility to stressors.The relationship between frailty assessment and elderly patients’ safety during perioperative period has received widespread attention.This paper reviews research progress of frailty assessment in elderly patients during perioperative period in the department of urology.
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【Objective】 To investigate the clinical features and prognostic factors of elderly patients with localized renal cell carcinoma after operation. 【Methods】 Clinical data of all elderly patients (60-100 years old) with localized renal cell carcinoma who underwent primary tumor resection during 2004 and 2017 in United States National Cancer Institute (SEER) database were collected.The clinical features, surgical methods and prognosis were analyzed.According to the surgical methods, the patients were divided into partial nephrectomy (PN) group and radical nephrectomy (RN) group.The effects of the two surgical methods on the prognosis were compared. 【Results】 A total of 20 348 patients were included.The median survival time was 164 months, and the 3-, 5- and 10-year cumulative overall survival rates were 91.1%, 84.2% and 64.4%, respectively.Multivariate Cox analysis showed that age, sex, race, histological grade, T stage and surgical method were independent prognostic factors for overall survival (P0.05). 【Conclusion】 Old age, male, black, non-chromophobe cell carcinoma, low degree of differentiation, high T stage of tumor and RN are independent risk factors for the prognosis of elderly patients with localized renal cell carcinoma.PN is the main treatment method and has remarkable therapeutic effects.
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@#Objective To investigate the efficacy and safety of Cyberknife in the treatment of elderly patients(aged≥75 years)with early stage non-small cell lung cancer(NSCLC),and to compare the results with those of patients aged<75 years.Methods We retrospectively analyzed 75 patients with early(T1-2N0M0)NSCLC admitted to the 960th Hospital of Jinan People's Liberation Army from January 2013 to October 2019.There were 32(42.7%)patients aged<75 years,and 43(57.3%)patients aged≥75 years.All patients were treated with 45-66Gy/3-8F,60%-85%isodose line as the prescription dose to cover planning target volume(PTV),and irradiation once a day and five times a week.The clinical efficacy,survival status and radiotherapy toxicity of the two groups were compared,and the factors affecting the efficacy of elderly patients were analyzed.Results The disease control rates of patients aged<75 and≥75 years were 96.9%and 93.0%,respectively(P>0.05).The 5-year local control rate(LC),progression-free survival(PFS)and cancer-specific survival(CSS)were 70.9%and 85.4%,58.5%and 54.4%,and 70.4%and 64.5%,respectively(P>0.05).However,the overall survival(OS)of patients aged≥75 years was significantly lower than that of patients aged<75 years,and the 5-year OS was 49.2%and 68.2%,respectively(P<0.05).There was no significant difference in the treatment complications between the two groups(P>0.05).Multivariate analysis showed that biologic effective dose(BED)was an independent factor affecting OS in patients aged≥75 years.Conclusion Stereotactic body radiotherapy with cyberknife is a safe and effective treatment for elderly patients with early stage NSCLC who are not suitable for surgery.