Investigating the genomic alteration improved the clinical outcome of aged patients with lung carcinoma

Background Lung carcinoma is a common geriatric disease. The development of genotype-targeted therapies greatly improved the management of lung carcinoma. However, the treatment for old patients can be more complex than that for young individuals. Results To investigate the benefits of genetic detection for older patients with lung carcinoma, we explored the genomic profiling of 258 patients with more than 55 years using a targeted next generation sequencing, and some of these patients were treated with targeted therapies based on the results of genomic detection. KRAS codon 61 mutations were found in 15.2% KRAS-mutated patients, which tend to be co-existing with other classical activating mutations other than codons 12/13. Acquired EGFR C797S mutations were identified in 2 cases and ERBB2 amplification was identified in 1 case. All these 3 cases developed resistance to EGFR tyrosine kinase inhibitors and showed expected results of their followed therapies. The median progression-free survival and median overall survival of patients treated with molecular targeted therapies were better than those of patients treated with chemoradiotherapy alone. Conclusions Our findings revealed the specific genomic profiles of patients older than 55 years with lung carcinoma and suggested that these old patients have been benefit from the genetic detection, which helped identify druggable mutations and distinguish resistance mechanisms.

Transcheter aortic valve implantation as a method of treatment of chronic heart failure in elderly and old patients: Literature review (part 1)

Стеноз аортального клапана (АК) - самое частое приобретенное клапанное заболевание с растущей распространенностью из-за старения населения, требующее хирургического или эндоваскулярного вмешательства. Транскатетерная имплантация АК (Transcatheter Aortic Valve Implantation, TAVI) представляет собой настоящую революцию в области интервенционной кардиологии для лечения пациентов старческого возраста или из группы высокого риска с тяжелым симптомным стенозом АК. TAVI позволяет выполнять коррекцию аортального порока наиболее тяжелой группе больных ХСН с выраженной коморбидностью, которым противопоказано выполнение открытой операции по замене АК, для прерывания порочного круга в прогрессировании ХСН, стимуляции обратного ремоделирования миокарда, облегчения симптомов, улучшения качества жизни и прогноза больных, а также в качестве «моста» к трансплантации сердца. Благодаря разработке устройств нового поколения, TAVI превратилась из сложной и опасной процедуры в эффективную и безопасную методику. Наибольший научный интерес в настоящее время представляет изучение долговечности клапана и возможности расширения показаний к выполнению TAVI у категорий пациентов с низким хирургическим риском, а также более молодого возраста. Aortic valve (AV) stenosis is the most common acquired valvular disease with an increasing prevalence due to an aging population, requiring surgical or endovascular intervention. Transcatheter Aortic Valve Implantation (TAVI) represents a real revolution in the field of interventional cardiology for the treatment of elderly or high-risk patients with severe symptomatic AV stenosis. TAVI allows for the correction of aortic defect in the most severe group of patients with chronic heart failure (CHF) with severe comorbidity, who are contraindicated for open surgery to replace AV, in order to interrupt the vicious circle in the progression of CHF, stimulate reverse myocardial remodeling, alleviate symptoms, improve the quality of life, and prognosis of patients, and also as a «bridge» to heart transplantation. With the development of next-generation devices, TAVI has evolved from a complex and dangerous procedure to an effective and safe technique. Currently, the greatest scientific interest is the study of valve durability and the possibility of expanding the indications for performing TAVI in categories of patients with low surgical risk, as well as in younger age groups.

A Non-Endemic Analysis of the Patterns and Prognosis of De Novo Metastatic Nasopharyngeal Carcinomas in Old Patients Aged ≥65 years

This study aimed to investigate the prognostic factors related to overall survival (OS) and cancer-specific survival (CSS) in patients with de novo metastatic nasopharyngeal carcinoma (NPC) aged ≥65 years in non-endemic areas. The Surveillance, Epidemiology, and End Results (SEER) database was queried for elderly patients with M1 stage NPC at initial diagnosis between 2004 and 2016. This study examined 100 patients and evaluated the relationship of gender, age, race, pathological grade, T stage, N stage, number of primary tumors, site of metastasis, number of metastatic organs, and other related factors with OS and CSS. The median survival and follow-up time were 10 and 48 months, respectively. The survival curves of race, N stage, bone metastasis, radiation, and chemotherapy significantly affected OS on the log-rank test. Race, bone metastasis, and chemotherapy were independent prognostic factors of OS. Bone metastasis was associated with poor survival. The survival curves of CSS were significantly differed between races, the number of primary tumors, and bone metastasis. In Cox regression multivariate analysis, only the number of primary tumors had an independent effect on prognosis. This study revealed that chemotherapy prolonged survival in elderly patients with metastatic NPC, whereas bone metastasis shortened survival.

Association Between Triglyceride Glucose Index and Carotid Artery Plaque in Different Glucose Metabolic States in Patients with Coronary Heart Disease — A RCSCD-TCM Study in China

BackgroundThe triglyceride glucose (TyG) index serves as a surrogate indicator of insulin resistance. However, there are limited data on the association between TyG index and carotid artery plaque (CAP) in patients with coronary heart disease (CHD).MethodsA total of 10,535 CHD patients were included in this study. TyG index was divided into quartiles, Q1: TyG index ＜ 8.52, Q2: 8.52 ≤ TyG index ＜ 8.93, Q3: 8.93 ≤ TyG index ≤ 9.40, Q4: TyG index ＞9.40. Logistic regression was used to analyze the relationship between TyG index and CAP in CHD patients, and further analyzed the relationship between TyG index and CAP in different genders, different age groups and different glucose metabolism states. ResultsA baseline analysis of CHD patients divided into four groups according to the quartile of the TyG index showed that there were significant differences in related parameters between the groups. As the TyG index increases, the incidence of CAP increases significantly. After adjustment for multivariate, TyG index levels for Q3 and Q4 correlated with increased OR in CAP, which Q4 has the highest correlation (OR: 1.42; 95% CI: 1.33 -1.53). The correlation between the Tyg index of female (OR:1.38; 95% CI: 1.31-1.45) and CAP was higher than that of male (OR:1.23; 95% CI: 1.16, 1.30). The OR value of middle-aged (≤ 60 years old) patients (OR:1.14; 95% CI: 1.07-1.22) is higher than that of elderly (＞dayu 60 years old) patients (OR:1.07; 95% CI: 1.02-1.13). Under different glucose metabolism states, the TyG index of CHD patients was significantly related to the risk of CAP, and the OR value of diabetes (DM) was the highest (OR: 1.35; 95% CI: 1.26-1.45).ConclusionsThere is a significant correlation between the TyG index and CAP in CHD patients. In addition, the correlation between TyG index and CAP in CHD patients is higher in female than in male, and the correlation in middle-aged and elderly patients is higher than that in elderly patients. Under the condition of DM, the correlation between TyG index and carotid artery plaque in CHD patients is higher.

Nhận xét đặc điểm lâm sàng, cận lâm sàng và kết quả hóa trị bệnh u lá nuôi thời kỳ thai nghén tại Bệnh viện K

TÓM TẮT Mục tiêu: Nhận xét một số đặc điểm lâm sàng, cận lâm sàng và kết quả hóa trị bệnh u lá nuôi thời kỳ thai nghén. Phương pháp: Nghiên cứu mô tả hồi cứu kết hợp tiến cứu. 36 bệnh nhân nữ được chẩn đoán xác định là u lá nuôi thời kỳ thai nghén từ tháng 01/2015 đến 10/2020, được phân loại thành nhóm nguy cơ thấp và cao. Nhóm nguy cơ thấp được điều trị bằng Methotrexate đơn trị. Nhóm nguy cơ cao được điều trị phác đồ EMA/CO (etoposide, methotrexate, actinomycin D/leucovorin calcium, vincristine, cyclophosphamide). Kết quả: Tuổi hay gặp nhất là > 40 tuổi. Số bệnh nhân vào viện vì ra máu âm đạo chiếm cao nhất 52,8%. Đa số bệnh nhân có Beta - HCG ban đầu < 100000 chiếm 83,3%. Thể mô bệnh học hay gặp nhất là ung thư nhau thai với 50%. Tổn thương di căn phổi chiếm cao nhất 53,8%. Tỷ lệ bệnh nhân có nguy cơ thấp và cao là như nhau chiếm 50%. Phác đồ Methotrexate đơn thuần: đáp ứng hoàn toàn là 83,3%. Phác đồ EMA/CO: tỷ lệ đáp ứng chung là 83,3%. Tỷ lệ bệnh nhân có độc tính độ 3,4 chiếm tỷ lệ nhỏ, chủ yếu trên huyết học. Kết luận: Các phác đồ cho kết quả tốt, tỷ lệ đáp ứng cao và an toàn. ABSTRACT REMARKS ON CHARACTERISTICS OF CLINICAL, SUBCLINICAL, AND RESULTS OF CHEMOTHERAPY ON GESTATIONAL TROPHOBLASTIC NEOPLASIA PATIENTS IN K HOSPITAL Objective: To remark characteristics of clinical, subclinical, and results of chemotherapy on gestational trophoblastic neoplasia patients. Methods: A retrospective combined prospective study was conducted on 36 women with low and high risks of gestational trophoblastic neoplasia from January 2015 to October 2020. The low - risk group was treated with methotrexate alone. The high - risk group was treated with EMA/CO (etoposide, methotrexate, actinomycin D/ leucovorin calcium, vincristine, cyclophosphamide). Results: The most common age was > 40 years old. Patients admitted to the hospital because of vaginal bleeding accounted for the highest rate of 52.8%. Most of the patients (83.3%) had initial Beta - HCG < 100000. The most common histopathological form is choriocarcinoma, with 50%. Lung metastatic lesions accounted for the highest (53.8%). The proportion of low - risk and high - risk patients was about 50%. The complete response rate was 83,3% with the methotrexate regimen and was 83,3% with EMA/CO regimen. The proportion of patients with grade 3.4 toxicity accounted for a small proportion, mainly in hematology. Conclusion: The regimens had good results, high response rates, and safety. Keyword: Gestational trophoblastic neoplasia, methotrexate, EMA/CO.

Differentially Expressed Genes Reveal the Biomarkers and Molecular Mechanism of Osteonecrosis

Osteonecrosis is one of the most refractory orthopedic diseases, which seriously threatens the health of old patients. High-throughput sequencing (HTS) and microarray analysis have confirmed as an effective way for investigating the pathological mechanism of disease. In this study, GSE7716, GSE74089, and GSE123568 were obtained from Gene Expression Omnibus (GEO) database and used to identify differentially expressed genes (DEGs) by R language. Subsequently, the DEGs were analyzed with Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment. Moreover, the protein-protein interaction (PPI) network of DEGs was analyzed by STRING database and Cytoscape. The results showed that 318 downregulated genes and 58 upregulated genes were observed in GSE7116; 690 downregulated genes and 1148 upregulated genes were screened from 34183 genes in GSE74089. The DEGs involved in progression of osteonecrosis involved inflammation, immunological rejection, and bacterial infection-related pathways. The GO enrichment showed that osteonecrosis was related with extracellular matrix, external encapsulating structure organization, skeletal system development, immune response activity, cell apoptosis, mononuclear cell differentiation, and serine/threonine kinase activity. Moreover, PPI network showed that the progression of osteonecrosis of the femoral head was related with CCND1, CDH1, ESR1, SPP1, LOX, JUN, ITGA, ABL1, and VEGF, and osteonecrosis of the jaw is related with ACTB, CXCR4, PTPRC, IL1B, CXCL8, TNF, JUN, PTGS2, FOS, and RHOA. In conclusion, this study identified the hub factors and pathways which might play important roles in progression of osteonecrosis and could be used as potential biomarkers for diagnosis and treatment of osteonecrosis.

The association between geriatric treatment and 30-day readmission risk among medical inpatients aged ≥75 years with multimorbidity

Background Readmission to hospital is frequent among older patients and reported as a post-discharge adverse outcome. The effect of treatment in a geriatric ward for acutely admitted older patients on mortality and function is well established, but less is known about the possible influence of such treatment on the risk of readmission, particularly in the oldest and most vulnerable patients. Our aim was to assess the risk for early readmission for multimorbid patients > 75 years treated in a geriatric ward compared to medical wards and to identify risk factors for 30-day readmissions. Methods Prospective cohort study of patients acutely admitted to a medical department at a Norwegian regional hospital. Eligible patients were community-dwelling, multimorbid, receiving home care services, and aged 75+. Patients were consecutively included in the period from 1 April to 31 October 2012. Clinical data were retrieved from the referral letter and medical records. Results We included 227 patients with a mean (SD) age of 86.0 (5.7) years, 134 (59%) were female and 59 (26%) were readmitted within 30 days after discharge. We found no statistically significant difference in readmission rate between patients treated in a geriatric ward versus other medical wards. In adjusted Cox proportional hazards regression analyses, lower age (hazard ratio (95% confidence interval) 0.95 (0.91–0.99) per year), female gender (2.17 (1.15–4.00)) and higher MMSE score (1.03 (1.00–1.06) per point) were significant risk factors for readmission. Conclusions Lower age, female gender and higher cognitive function were the main risk factors for 30-day readmission to hospital among old patients with multimorbidity. We found no impact of geriatric care on the readmission rate.