The scarcity of ideal liver grafts for orthotopic liver transplantation (OLT) has led transplant teams to investigate other sources of grafts in order to augment the donor liver pool. One way to get more liver grafts ...The scarcity of ideal liver grafts for orthotopic liver transplantation (OLT) has led transplant teams to investigate other sources of grafts in order to augment the donor liver pool. One way to get more liver grafts is to use marginal donors, a not well-defined group which includes mainly donors > 60 years, donors with hypernatremia or macrosteatosis > 30%, donors with hepatitis C virus or hepatitis B virus positive serologies, cold ischemia time > 12 h, non-heart-beating donors, and grafts from split-livers or living-related donations. Perhaps the most practical and frequent measure to increase the liver pool, and thus to reduce waiting list mortality, is to use older livers. In the past years the results of OLT with old livers have improved, mainly due to better selection and maintenance of donors, improvements in surgical techniques in donors and recipients, and intra- and post-OLT management. At the present time, sexagenarian livers are generally accepted, but there still exists some controversy regarding the use of septuagenarian and octogenarian liver grafts. The aim of this paper is to briefly review the aging process of the liver and reported experiences using old livers for OLT. Fundamentally, the series of septuagenarian and octogenarian livers will be addressed to see if there is a limit to using these aged grafts.展开更多
Background:To create and validate nomograms for the personalized prediction of survival in octogenarians with newly diagnosed nonsmall-cell lung cancer(NSCLC)with sole brain metastases(BMs).Methods:Random forests(RF)w...Background:To create and validate nomograms for the personalized prediction of survival in octogenarians with newly diagnosed nonsmall-cell lung cancer(NSCLC)with sole brain metastases(BMs).Methods:Random forests(RF)were applied to identify independent prognostic factors for building nomogram models.The predictive accuracy of the model was evaluated based on the receiver operating characteristic(ROC)curve,C-index,and calibration plots.Results:The area under the curve(AUC)values for overall survival at 6,12,and 18 months in the validation cohort were 0.837,0.867,and 0.849,respectively;the AUC values for cancer-specific survival prediction were 0.819,0.835,and 0.818,respectively.The calibration curves visualized the accuracy of the model.Conclusion:The new nomograms have good predictive power for survival among octogenarians with sole BMs related to NSCLC.展开更多
Background:To evaluate the effectiveness and safety of cabazitaxel in castration-resistant prostate cancer patients aged>80 years,we performed a retrospective study on a sample of patients from 11 Italian cancer ce...Background:To evaluate the effectiveness and safety of cabazitaxel in castration-resistant prostate cancer patients aged>80 years,we performed a retrospective study on a sample of patients from 11 Italian cancer centers.Materials and methods:Fifty-seven patients aged>80 years were treated with cabazitaxel after previous failure with docetaxel;39 completed a comprehensive geriatric assessment questionnaire(34 fit and 5 vulnerable)and 8 patients(14%)had an Eastern Cooperative Oncology Group performance status(PS)>2,while most had a PS of 0-1(86%).Cabazitaxel was administered at a dose of 25 mg/m^(2)in 30(52%)patients and 20 mg/m^(2)or adapted schedules in 27(48%)patients.These schedules were adopted mainly in patients>85 years(75%),with a PS>2(87.5%),and those classified as vulnerable(100%).Results:The duration of treatment was 4.8 months and was comparable in all subgroups;disease control rate was reported in 36 patients(63%);prostate-specific antigen response was recorded in 18 patients(31.5%).Median overall survival was 13.1 months regardless of age(<85/>85 years),but overall survival was reduced in vulnerable(7.2 months)and PS>2 patients(6.8 months).The most frequently documented grade 3-4 toxicities were neutropenia(14%)and diarrhea(10.5%).Six patients(10.5%)dropped out due to severe toxicity.Conclusions:Octogenarian patients can be treated with cabazitaxel with reduced doses or alternative schedules that are associated with less toxicity and fewer treatment interruptions.Comprehensive geriatric assessment could facilitate more appropriate patient selection.展开更多
Background The efficacy and safety of non-vitamin K antagonist oral anticoagulants （NOACs） and warfarin in Asian octogenarian atrial fibrillation （AF） patients have not been established in a real-world setting. We...Background The efficacy and safety of non-vitamin K antagonist oral anticoagulants （NOACs） and warfarin in Asian octogenarian atrial fibrillation （AF） patients have not been established in a real-world setting. We aimed to evaluate the efficacy and safety of NOACs and warfarin in Korean octogenarian patients. Methods A total of 293 consecutive patients aged 〉 80 years with non-valvular AF who had taken either NOACs 048 cases, 50.5%） or warfarin （145 cases, 49.5%） were retrospectively reviewed. The efficacy outcome was the com- posite of stroke or systemic embolism. The safety outcome was major bleeding. Results The follow-up duration was 375 patient-years （ 172 patient-years with NOACs and 203 patient-years with warfarin）. Patients on NOACs were slightly older （P = 0.006） and had slightly higher HAS-BLED scores （P = 0.034）. The efficacy of both anticoagulants was high （1.16% for NOACs vs. 2.98% for warfarin per 100 pa- tient-years, P = 0.46）. The safety outcome was relatively high in both NOACs and warfarin groups （8.96% vs. 12.46%, P = 0.29）. The effi- cacy and safety outcomes tended to decrease non-significantly in low dose NOACs than in common dose NOACs or warfarin （0.85% vs. 1.84% vs. 2.98% in efficacy outcome, P = 0.69; and 6.97% vs. 13.29% vs. 12.46% in safety outcome, P = 0.34）. Conclusions NOACs were highly effective for prevention of stroke or systemic embolism in Asian octogenarian AF patients. However, major bleeding occurred excessively high in both anticoagulant groups. Further study is required on the optimal anticoagulant regimen in octogenarian population.展开更多
BACKGROUND The shortage of liver grafts and subsequent waitlist mortality led us to expand the donor pool using liver grafts from older donors.AIM To determine the incidence,outcomes,and risk factors for biliary compl...BACKGROUND The shortage of liver grafts and subsequent waitlist mortality led us to expand the donor pool using liver grafts from older donors.AIM To determine the incidence,outcomes,and risk factors for biliary complications(BC)in liver transplantation(LT)using liver grafts from donors aged>70 years.METHODS Between January 1994 and December 31,2019,297 LTs were performed using donors older than 70 years.After excluding 47 LT for several reasons,we divided 250 LTs into two groups,namely post-LT BC(n=21)and without BC(n=229).This retrospective case-control study compared both groups.RESULTS Choledocho-choledochostomy without T-tube was the most frequent technique(76.2%in the BC group vs 92.6%in the non-BC group).Twenty-one patients(8.4%)developed BC(13 anastomotic strictures,7 biliary leakages,and 1 nonanastomotic biliary stricture).Nine patients underwent percutaneous balloon dilation and nine required a Rouxen-Y hepaticojejunostomy because of dilation failure.The incidence of post-LT complications(graft dysfunction,rejection,renal failure,and non-BC reoperations)was similar in both groups.There were no significant differences in the patient and graft survival between the groups.Moreover,only three deaths were attributed to BC.While female donors were protective factors for BC,donor cardiac arrest was a risk factor.CONCLUSION The incidence of BC was relatively low on using liver grafts>70 years.It could be managed in most cases by percutaneous dilation or Roux-en-Y hepaticojejunostomy,without significant differences in the patient or graft survival between the groups.展开更多
AIM:To assess the outcomes of laparoscopic colorectal cancer resection in the octogenarian population at our institution.METHODS:Retrospective analysis of registry data accumulated prospectively were used in conjuncti...AIM:To assess the outcomes of laparoscopic colorectal cancer resection in the octogenarian population at our institution.METHODS:Retrospective analysis of registry data accumulated prospectively were used in conjunction with the data obtained from patient notes to identify outcome data for octogenarians who had undergone elective laparoscopic colorectal cancer resection.RESULTS:Laparoscopic colorectal cancer resections were performed in 68 octogenarians between 2003 and 2011 at our institution.Four operations(6%) were converted to an open technique.There were twelve cases of morbidity(18%) and two cases of mortality(3%).The overall median hospital stay was 8 d.The median time for a patient to be deemed surgically fit for discharge was 5 d reflecting a delay in provision of social care or stoma education.CONCLUSION:Our results support the view that laparoscopic surgery in octogenarians is safe,feasible and with a reduced length of stay.This is well reflected in our results which are compatible with United Kingdom national figures.展开更多
Background:Coronary artery disease(CAD)in octogenarians(age of>80 years)has a high risk of mortality and high expenses.Research shows that the prevalence of CAD is higher among octogenarians than that among younger...Background:Coronary artery disease(CAD)in octogenarians(age of>80 years)has a high risk of mortality and high expenses.Research shows that the prevalence of CAD is higher among octogenarians than that among younger people,but few such patients undergo percutaneous coronary intervention(PCI)or coronary artery bypass grafting(CABG).This study aimed to evaluate different treatments w让h respect to their clinical effects and impacts on quality of life of octogenarians with CAD.Methods:Data of 519 octogenarians with CAD consecutively treated at Beijing Anzhen Hospital,Capital Medical University(Beijing,China)from January 2010 to January 2016 were collected in this study.The patients were categorized into three groups based on the treatments they received:the PCI group(n=292),CABG group(n=110),and medical treatment group(n=117).The followings were recorded during follow-up:clinical data,death(all-cause and cardiovascular-related),re-hospitalization time,Seattle Angina Questionnaire(SAQ)score,and occurrence of hemorrhagic events(cerebral bleeding,gastrointestinal bleeding,and dermal ecchymosis).Results:The median follow-up duration was 25.0(25th,75th percentile:17.0,55.5)months among 417 patients.The all-cause death rates(28.2%vs.12.0%and 14.6%,respectively)and cardiovascular-related death rates(15.4%us.3.8%and 6.4%,respectively)were significantly higher in the medical treatment group than those in the PCI group and CABG group(all P<0.05).The re-hospitalization rate for cardiovascular events was significantly lower in the CABG group than those in the PCI group and medical treatment group(3.8%vs.12.8%and 14.9%,respectively)(x^2=8.23&P=0.018).The SAQ scores of physical limitation,angina frequency,treatment satisfaction,and disease perception were significantly higher in the PCI group and CABG group than those in the medical treatment group(all P<0.05).No significant difference in the angina stability score was observed among the three groups(F=3.179,P=0.204).Conclusion:PCI and CABG result in reduced mortality and better 展开更多
Objective To compare the long-term survival following transcatheter aortic valve implantation (TAVI) in an octogenarian population with that in a younger population.Methods This retrospective study included 274 patien...Objective To compare the long-term survival following transcatheter aortic valve implantation (TAVI) in an octogenarian population with that in a younger population.Methods This retrospective study included 274 patients that underwent TAVI for severe symptomatic aortic stenosis.The study group was divided into two age groups,as those with an age ≥ 80 years (octogenarians,n = 132),and age < 80 (younger patients,n = 142).The two groups were compared in terms of clinical outcomes and survival.In addition,significant predictors of survival were estimated.Results Non-cardiac mortality (during follow-up)(21.9% vs.10.5%,P = 0.01) and in-hospital stroke (8.3% vs.2.8%,P = 0.01) were more common among octogenarians.The two groups did not differ in terms of mean survival (41.0 ± 2.1 vs.38.2 ± 2.2 months,respectively,P =0.18).Multivariate analysis identified left ventricular ejection fraction < 35%(OR: 2.17,95% CI: 1.17–4.03;P = 0.01),preoperative of moderate to severe mitral insufficiency (OR: 1.88,95% CI: 1.15–3.06;P = 0.01),postoperative major and life-threating bleeding (OR: 2.49,95% CI: 1.05–5.89;P =0.03),and in-hospital stroke (OR: 2.29,95% CI: 1.04–5.04;P = 0.03) as potential predictors of poor survival.Conclusions In this study,similarly favorable survival outcomes were achieved in the elderly population as in younger patients,despite the presence of comorbid conditions.A consideration should be given to non-surgical management of severe aortic stenosis with the TAVI procedure in elderly patients,in the absence of co-existent conditions associated with shortened life expectancy.展开更多
Nlu Ben, an 83-year-old actor, was encouraged by President Xi Jinping to play a vanguardand exemplary rote as a member of the Communist Party of China （CPC） in a letter on June25.
文摘The scarcity of ideal liver grafts for orthotopic liver transplantation (OLT) has led transplant teams to investigate other sources of grafts in order to augment the donor liver pool. One way to get more liver grafts is to use marginal donors, a not well-defined group which includes mainly donors > 60 years, donors with hypernatremia or macrosteatosis > 30%, donors with hepatitis C virus or hepatitis B virus positive serologies, cold ischemia time > 12 h, non-heart-beating donors, and grafts from split-livers or living-related donations. Perhaps the most practical and frequent measure to increase the liver pool, and thus to reduce waiting list mortality, is to use older livers. In the past years the results of OLT with old livers have improved, mainly due to better selection and maintenance of donors, improvements in surgical techniques in donors and recipients, and intra- and post-OLT management. At the present time, sexagenarian livers are generally accepted, but there still exists some controversy regarding the use of septuagenarian and octogenarian liver grafts. The aim of this paper is to briefly review the aging process of the liver and reported experiences using old livers for OLT. Fundamentally, the series of septuagenarian and octogenarian livers will be addressed to see if there is a limit to using these aged grafts.
基金supported by the key specialty of traditional Chinese medicine promotion project
文摘Background:To create and validate nomograms for the personalized prediction of survival in octogenarians with newly diagnosed nonsmall-cell lung cancer(NSCLC)with sole brain metastases(BMs).Methods:Random forests(RF)were applied to identify independent prognostic factors for building nomogram models.The predictive accuracy of the model was evaluated based on the receiver operating characteristic(ROC)curve,C-index,and calibration plots.Results:The area under the curve(AUC)values for overall survival at 6,12,and 18 months in the validation cohort were 0.837,0.867,and 0.849,respectively;the AUC values for cancer-specific survival prediction were 0.819,0.835,and 0.818,respectively.The calibration curves visualized the accuracy of the model.Conclusion:The new nomograms have good predictive power for survival among octogenarians with sole BMs related to NSCLC.
文摘Background:To evaluate the effectiveness and safety of cabazitaxel in castration-resistant prostate cancer patients aged>80 years,we performed a retrospective study on a sample of patients from 11 Italian cancer centers.Materials and methods:Fifty-seven patients aged>80 years were treated with cabazitaxel after previous failure with docetaxel;39 completed a comprehensive geriatric assessment questionnaire(34 fit and 5 vulnerable)and 8 patients(14%)had an Eastern Cooperative Oncology Group performance status(PS)>2,while most had a PS of 0-1(86%).Cabazitaxel was administered at a dose of 25 mg/m^(2)in 30(52%)patients and 20 mg/m^(2)or adapted schedules in 27(48%)patients.These schedules were adopted mainly in patients>85 years(75%),with a PS>2(87.5%),and those classified as vulnerable(100%).Results:The duration of treatment was 4.8 months and was comparable in all subgroups;disease control rate was reported in 36 patients(63%);prostate-specific antigen response was recorded in 18 patients(31.5%).Median overall survival was 13.1 months regardless of age(<85/>85 years),but overall survival was reduced in vulnerable(7.2 months)and PS>2 patients(6.8 months).The most frequently documented grade 3-4 toxicities were neutropenia(14%)and diarrhea(10.5%).Six patients(10.5%)dropped out due to severe toxicity.Conclusions:Octogenarian patients can be treated with cabazitaxel with reduced doses or alternative schedules that are associated with less toxicity and fewer treatment interruptions.Comprehensive geriatric assessment could facilitate more appropriate patient selection.
文摘Background The efficacy and safety of non-vitamin K antagonist oral anticoagulants （NOACs） and warfarin in Asian octogenarian atrial fibrillation （AF） patients have not been established in a real-world setting. We aimed to evaluate the efficacy and safety of NOACs and warfarin in Korean octogenarian patients. Methods A total of 293 consecutive patients aged 〉 80 years with non-valvular AF who had taken either NOACs 048 cases, 50.5%） or warfarin （145 cases, 49.5%） were retrospectively reviewed. The efficacy outcome was the com- posite of stroke or systemic embolism. The safety outcome was major bleeding. Results The follow-up duration was 375 patient-years （ 172 patient-years with NOACs and 203 patient-years with warfarin）. Patients on NOACs were slightly older （P = 0.006） and had slightly higher HAS-BLED scores （P = 0.034）. The efficacy of both anticoagulants was high （1.16% for NOACs vs. 2.98% for warfarin per 100 pa- tient-years, P = 0.46）. The safety outcome was relatively high in both NOACs and warfarin groups （8.96% vs. 12.46%, P = 0.29）. The effi- cacy and safety outcomes tended to decrease non-significantly in low dose NOACs than in common dose NOACs or warfarin （0.85% vs. 1.84% vs. 2.98% in efficacy outcome, P = 0.69; and 6.97% vs. 13.29% vs. 12.46% in safety outcome, P = 0.34）. Conclusions NOACs were highly effective for prevention of stroke or systemic embolism in Asian octogenarian AF patients. However, major bleeding occurred excessively high in both anticoagulant groups. Further study is required on the optimal anticoagulant regimen in octogenarian population.
文摘BACKGROUND The shortage of liver grafts and subsequent waitlist mortality led us to expand the donor pool using liver grafts from older donors.AIM To determine the incidence,outcomes,and risk factors for biliary complications(BC)in liver transplantation(LT)using liver grafts from donors aged>70 years.METHODS Between January 1994 and December 31,2019,297 LTs were performed using donors older than 70 years.After excluding 47 LT for several reasons,we divided 250 LTs into two groups,namely post-LT BC(n=21)and without BC(n=229).This retrospective case-control study compared both groups.RESULTS Choledocho-choledochostomy without T-tube was the most frequent technique(76.2%in the BC group vs 92.6%in the non-BC group).Twenty-one patients(8.4%)developed BC(13 anastomotic strictures,7 biliary leakages,and 1 nonanastomotic biliary stricture).Nine patients underwent percutaneous balloon dilation and nine required a Rouxen-Y hepaticojejunostomy because of dilation failure.The incidence of post-LT complications(graft dysfunction,rejection,renal failure,and non-BC reoperations)was similar in both groups.There were no significant differences in the patient and graft survival between the groups.Moreover,only three deaths were attributed to BC.While female donors were protective factors for BC,donor cardiac arrest was a risk factor.CONCLUSION The incidence of BC was relatively low on using liver grafts>70 years.It could be managed in most cases by percutaneous dilation or Roux-en-Y hepaticojejunostomy,without significant differences in the patient or graft survival between the groups.
文摘AIM:To assess the outcomes of laparoscopic colorectal cancer resection in the octogenarian population at our institution.METHODS:Retrospective analysis of registry data accumulated prospectively were used in conjunction with the data obtained from patient notes to identify outcome data for octogenarians who had undergone elective laparoscopic colorectal cancer resection.RESULTS:Laparoscopic colorectal cancer resections were performed in 68 octogenarians between 2003 and 2011 at our institution.Four operations(6%) were converted to an open technique.There were twelve cases of morbidity(18%) and two cases of mortality(3%).The overall median hospital stay was 8 d.The median time for a patient to be deemed surgically fit for discharge was 5 d reflecting a delay in provision of social care or stoma education.CONCLUSION:Our results support the view that laparoscopic surgery in octogenarians is safe,feasible and with a reduced length of stay.This is well reflected in our results which are compatible with United Kingdom national figures.
文摘Background:Coronary artery disease(CAD)in octogenarians(age of>80 years)has a high risk of mortality and high expenses.Research shows that the prevalence of CAD is higher among octogenarians than that among younger people,but few such patients undergo percutaneous coronary intervention(PCI)or coronary artery bypass grafting(CABG).This study aimed to evaluate different treatments w让h respect to their clinical effects and impacts on quality of life of octogenarians with CAD.Methods:Data of 519 octogenarians with CAD consecutively treated at Beijing Anzhen Hospital,Capital Medical University(Beijing,China)from January 2010 to January 2016 were collected in this study.The patients were categorized into three groups based on the treatments they received:the PCI group(n=292),CABG group(n=110),and medical treatment group(n=117).The followings were recorded during follow-up:clinical data,death(all-cause and cardiovascular-related),re-hospitalization time,Seattle Angina Questionnaire(SAQ)score,and occurrence of hemorrhagic events(cerebral bleeding,gastrointestinal bleeding,and dermal ecchymosis).Results:The median follow-up duration was 25.0(25th,75th percentile:17.0,55.5)months among 417 patients.The all-cause death rates(28.2%vs.12.0%and 14.6%,respectively)and cardiovascular-related death rates(15.4%us.3.8%and 6.4%,respectively)were significantly higher in the medical treatment group than those in the PCI group and CABG group(all P<0.05).The re-hospitalization rate for cardiovascular events was significantly lower in the CABG group than those in the PCI group and medical treatment group(3.8%vs.12.8%and 14.9%,respectively)(x^2=8.23&P=0.018).The SAQ scores of physical limitation,angina frequency,treatment satisfaction,and disease perception were significantly higher in the PCI group and CABG group than those in the medical treatment group(all P<0.05).No significant difference in the angina stability score was observed among the three groups(F=3.179,P=0.204).Conclusion:PCI and CABG result in reduced mortality and better
文摘Objective To compare the long-term survival following transcatheter aortic valve implantation (TAVI) in an octogenarian population with that in a younger population.Methods This retrospective study included 274 patients that underwent TAVI for severe symptomatic aortic stenosis.The study group was divided into two age groups,as those with an age ≥ 80 years (octogenarians,n = 132),and age < 80 (younger patients,n = 142).The two groups were compared in terms of clinical outcomes and survival.In addition,significant predictors of survival were estimated.Results Non-cardiac mortality (during follow-up)(21.9% vs.10.5%,P = 0.01) and in-hospital stroke (8.3% vs.2.8%,P = 0.01) were more common among octogenarians.The two groups did not differ in terms of mean survival (41.0 ± 2.1 vs.38.2 ± 2.2 months,respectively,P =0.18).Multivariate analysis identified left ventricular ejection fraction < 35%(OR: 2.17,95% CI: 1.17–4.03;P = 0.01),preoperative of moderate to severe mitral insufficiency (OR: 1.88,95% CI: 1.15–3.06;P = 0.01),postoperative major and life-threating bleeding (OR: 2.49,95% CI: 1.05–5.89;P =0.03),and in-hospital stroke (OR: 2.29,95% CI: 1.04–5.04;P = 0.03) as potential predictors of poor survival.Conclusions In this study,similarly favorable survival outcomes were achieved in the elderly population as in younger patients,despite the presence of comorbid conditions.A consideration should be given to non-surgical management of severe aortic stenosis with the TAVI procedure in elderly patients,in the absence of co-existent conditions associated with shortened life expectancy.
文摘Nlu Ben, an 83-year-old actor, was encouraged by President Xi Jinping to play a vanguardand exemplary rote as a member of the Communist Party of China （CPC） in a letter on June25.
