Midpalatal suture opening: A normative study

AGA Clinical Practice Update on Management of Inflammatory Bowel Disease in Elderly Patients: Expert Review

In adolescents and young adults, primary hyperparathyroidism (PHPT) is an uncommon diagnosis. We compared the clinical characteristics of these patients to those of older adult patients with PHPT. We hypothesized that PHPT in adolescents and young adults is more often caused by single-gland disease and is amenable to minimally invasive parathyroidectomy (MIP). We retrospectively reviewed the medical records of 452 consecutive patients who had surgery for PHPT. Patients ranged in age from 13 to 94 years and were dichotomized into younger (age <30 years, n = 17, 3.8%) and older (age ≥ 30 years, n = 435, 96.2%) patients. Continuous baseline and intraoperative and postoperative measures were not normally distributed and were summarized with medians and interquartile ranges (IQRs). Groups were compared using Wilcoxon rank sum test or Fisher exact test, and significance was set at P < .05. Median [IQR] age was 24 [23-27] years for the younger group and 58 [51-66] years for the older group. Though not statistically significant, a smaller proportion of the younger patients compared with the older patients had a positive (99m)Tc-sestamibi scan (71%; 95% confidence interval [95% CI] = 44-90% vs. 83%; 95% CI = 79-86%) and showed a suspected parathyroid adenoma on ultrasound (65%; 95% CI = 38-86% vs. 80%; 95% CI = 76-83%). The younger and older age groups did not significantly differ on preoperative serum PTH levels (median [IQR]: 111 [76-145] pg/ml vs 110 [84-152] pg/ml; P = .73 respectively). The younger group had higher serum calcium levels (11.6 [11.1-12.2] mg/dl) compared with the older group (11.1 [10.7-11.5] mg/dl; P = .01). MIP was performed less frequently on the younger patients (70.6%) compared with older patients (88.7%; P = 0.04). Though the incidence of a single adenoma was somewhat more frequent in older patients (90%; 95% CI = 87-93%) than in younger patients (82%; 95% CI = 57-96%) it was the most frequent cause of PHPT in the younger patients. The younger and older groups did not significantly differ on percent drop from baseline for intraoperative PTH monitoring (81.7 vs 79.3%; P = .46), respectively. Younger patients with PHPT present with significantly higher serum calcium levels than older patients. However, younger patients are less likely to localize abnormal parathyroid glands on sestamibi or ultrasound. Though younger patients appear to have a higher incidence of hyperplasia compared with older patients, single gland disease is still the overall most frequent cause. Our data suggest that MIP should be more frequently considered in younger patients because of the high incidence of single gland disease.

To evaluate the safety and efficacy of neoadjuvant therapy (NAT), followed by surgical resection in patients with pancreatic ductal adenocarcinoma (PDAC) aged ≥75 years. Whether administration of NAT, followed by surgical resection in elderly patients with PDAC is safe and effective is unknown. The present study is a three-part comparison of older (≥75 years) versus younger (<75 years) patients in different settings throughout the continuum of PDAC care. The first analysis was a comparison of older versus younger consecutive patients with nonmetastatic PDAC who were initiated on FOLFIRINOX. The second was a comparison of older versus younger patients who underwent NAT, followed by surgical resection, and the third and final analysis was a comparison of older patients who underwent either NAT, followed by surgical resection versus upfront surgical resection. Postoperative complications, overall survival (OS), and time to recurrence (TTR) were compared. Propensity score matching (PSM) analysis was performed to adjust for potential confounders. In the first analysis, a lower proportion of older patients (n = 40) were able to complete the intended neoadjuvant FOLFIRINOX (8) cycles compared with younger patients (n = 214; 65.0% vs 81.4%, P = 0.021). However, older patients were just as likely to undergo surgical exploration as younger patients (77.5% vs 78.5%, P = 0.89), as well as surgical resection (57.5% vs 55.6%, P = 0.70). In the second analysis, PSM was conducted to compare older (n = 54) versus younger patients (n = 54) who underwent NAT, followed by surgical resection. There were no significant differences in postoperative complications between the matched groups. While there was a significant difference in OS between older and younger patients (median OS: 16.43 vs 30.83 months, P = 0.002), importantly, there was no significant difference in TTR (median: 7.65 vs 11.83 months, P = 0.215). In the third analysis, older patients who underwent NAT, followed by surgical resection (n = 48) were compared with similar older patients who underwent upfront surgical resection (n = 48). After PSM, there was a significant difference in OS (median OS: 15.78 months vs 11.51 months, P = 0.037), as well as TTR (median TTR: 8.81 vs 7.10 months, P = 0.046) representing an association with improved outcomes that favored the neoadjuvant approach among older patients alone. This comprehensive three-part study showed that administration of NAT, followed by surgical resection, seems to be safe and effective among patients ≥75 years of age. An aggressive approach should be offered to older adults undergoing multimodal treatment of PDAC.

Since the initial scientific statement on Secondary Prevention of Coronary Heart Disease (CHD) in the Elderly was published in 2002,1 several trends have continued that make an update highly appropriate. First, the graying of the US population and those of other industrialized countries has progressed unabated because more adults are surviving into their senior years. The number of Americans aged ≥75 years was estimated at 18.6 million in 2010, representing ≈6% of the population,2 and it is expected to double by 2050. The population aged ≥85 years is growing the most rapidly, with numbers expected to reach 19.5 million by 2040. In 2008, 67% of the 811 940 cardiovascular deaths in the United States occurred in people aged ≥75 years.3 In parallel to this increase in the older adult demographic, the number of Americans with CHD has increased to an estimated 16.3 million, more than half of whom are >65 years of age.3 Similarly, 7 million have had a stroke, the incidence of which approximately doubles with successive age decades after 45 to 54 years.3 Peripheral artery disease (PAD) affects 8 to 10 million Americans, the majority of whom are >65 years of age. Between 2015 and 2030, annual US costs related to atherosclerotic cardiovascular disease (ASCVD) are projected to increase from $84.8 billion to $202 billion.3 Moreover, given that ASCVD often undermines functional capacity and independence and increases reliance on long-term care, indirect expenses related to ASCVD are also expected to increase. Thus, the need for effective secondary prevention measures in the older adult population with known ASCVD has never been greater. Notably, the 2011 American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) updated guidelines for secondary prevention of CHD broadened …

Transverse maxillary deficiency is a relatively common type of malocclusion, that if left untreated will probably affect the permanent dentition. Recent investigations have proposed the use of bone-supported miniscrews around the midpalatal suture to expand the palate in late adolescents. The aim of this systematic review was to assess the efficacy of the Miniscrew Assisted Rapid Palatal Expansion (MARPE) technique in young adult patients, by quantifying skeletal expansion in relation to the age of the patient, as well as the impact upon other craniofacial sutures, and to describe the possible dental side effects. An electronic and manual search was conducted, in which 17 were included in the study. The estimated mean palatal opening width and nasal cavity width was 2.99 ± 0.33 mm and 2.24 ± 0.17 mm, respectively. A significant association was observed between midpalatal and pterygoid suture opening (p=0.010). No association was found between age and the MARPE technique (p=0.701). The results of this study show that the MARPE technique produces significant opening width in young adults at both at midpalatal suture and nasal cavity level, and apparently only significantly widens the pterygoid suture. Greater dental side effects are directly associated to a reduced midpalatal suture opening width.

The Exportin, CSE1L, Regulates Ribosome Biogenesis and Is a Selective Dependency in Childhood and Young Adult Acute Myeloid Leukemia

Skeletal and dental changes in the sagittal, vertical, and transverse dimensions after rapid palatal expansion

Introduction/BackgroundEpithelial ovarian cancer (EOC) is the most lethal gynaecological cancer for which long-term survival is conditioned by surgery and chemotherapy. Striking a balance between this comprehensive treatment combination and the...

To assess, post hoc, tofacitinib safety/effectiveness in patients with ulcerative colitis (UC), stratified by age, using data from a 60-week post-marketing surveillance (PMS) study in Japan. All patients with UC receiving tofacitinib in Japan were enrolled in a large PMS study. Incidence proportions of adverse events (AEs), incidence rates (IRs; unique patients with events/100 patient-years of exposure) of clinically important AEs, reasons for discontinuation, and partial Mayo score clinical remission, stratified by age ( ≥ 65 and < 65 years), were evaluated. The analysis included 212 older ( ≥ 65 years) and 1,770 younger ( < 65 years) patients. Demographics and baseline disease characteristics were generally similar between groups; however, more older versus younger patients had cardiovascular disease (23.1% vs. 4.6%). Incidence proportions of AEs were comparable between groups, but IRs (95% confidence intervals) in older versus younger patients were numerically higher for herpes zoster (9.81 [5.72-15.71] vs. 5.44 [4.28-6.82]), and higher for serious infections (4.45 [1.92-8.76] vs. 1.14 [0.65-1.85]). More older versus younger patients discontinued due to AEs (28.6% vs. 17.6%); more younger versus older patients discontinued due to insufficient clinical responses (50.3% vs. 35.2%). Clinical remission rates through 60 weeks were generally similar between groups. Older patients had higher IRs of herpes zoster and serious infection than younger patients, although tofacitinib effectiveness was similar between age groups. Discontinuation due to AEs was more common in older patients. Despite the smaller sample size of older versus younger patients, a focused evaluation of older patients is of benefit.

Celiac disease is an autoimmune enteropathy with variable clinical symptoms. Elderly patients can have different manifestations from those of young patients. The aims of the present study were to investigate whether any differences or similarities exist between older and young patients with celiac disease with a special emphasis on concurrent autoimmune diseases. Celiac disease patients were stratified as older and younger patients. These two groups were then compared by means of clinical symptoms, laboratory parameters and concurrent autoimmune diseases. Factors associated with the presence of an autoimmune disease were identified by univariate and multivariate analysis. There were 66 older patients (mean age 67.7 ± 3.2 years, 50 women), and 277 younger patients (mean age 35.9 ± 11.7 years, 207 women). Of the 66 older patients, eight patients had gastrointestinal symptoms and 58 patients had extradigestive symptoms. In the younger group, the number of patients referred due to gastrointestinal symptoms was higher (8 [12.2%] vs 200 (72.2%), P < 0.001) compared with the older group. Whereas 10 (15.1%) older patients showed polyautoimmunity, 55 (19.8%) younger patients had polyautoimmunity. Multiple autoimmune syndrome was more common in older patients compared with young patients (31 [47%] vs 12 [4%], P < 0.001, respectively). The presentation of celiac disease clinically, histologically and by means of laboratory parameters is different in older and young patients. Polyautoimmunity and multiple autoimmune syndrome are more common in older patients compared with younger patients. A biopsy score of Marsh score type, antinuclear antibody positivity, high serum anti-tissue transglutaminase immunoglobulin A level and low hemoglobin level were risk factors for having an autoimmune disease. Geriatr Gerontol Int 2017; 17: 2060-2067.

11169 Background: Cancer has historically been considered a disease of older adults, however, several reports have shown an alarming rise in the incidence of early onset cancer, particularly gastrointestinal tumors and specially colorectal cancer. To date, there are no reports in this field from Latin America. This study aims to evaluate the trends in mortality rates of the most relevant gastrointestinal tumors among young versus older people in Chile. Methods: Nationwide data from the National Department of Statistics and Health Information was obtained from the years 1997 to 2023. Cause Specific Mortality was analysed for all ages, older ( ≥ 50 years) and younger (&lt;50 years) patients for all tumors, Colorectal, Gastric, Esophagus, Pancreas, Liver and Biliary Tract cancer. The trends of rates were analyzed using Joinpoint Trend Analysis Software for calculation of the annual percentage rate change (APC). Results: Cancer-related mortality in Chile is increasing. From 1997 to 2023, for all causes, there were 2,645,132 deaths, the APC for the overall population, for all cancers is 0.96% (0.63%-1.29%, p&lt;0.001). Gastrointestinal cancer accounted for 10%, with 261,300 deaths. When analyzed by type of cancer, an increase in mortality for colorectal cancer was observed, with a rate increase 90.5% higher in younger than older adults, with an APC of 3.24% and 1.7%, respectively. This difference was more evident in female adults. Pancreatic cancer mortality rate increased from 1997 to 2015 with an APC of 0.96% in older patients, but decreased from 2015 to 2023 with an APC of -0.87%. The mortality was steady in younger patients. No differences between younger and older patients were seen for Stomach, Esophagus, Biliary tract and Liver Cancer. Stomach cancer mortality rate has decreased in younger and older patients, with an APC of -1.61% and -2.63% respectively for the period from 1997 to 2015, and -5.87% and -4.77% respectively for the period from 2015 to 2023. Esophagus cancer mortality rate has decreased in younger and older patients, with an APC of -1.09% and -2.7% respectively for the period from 1997 to 2006, and -7.71% and -4.58% respectively for the period from 2006 to 2023. Biliary tract cancer mortality rate has decreased in younger and older patients, with an APC of -1.27% and -1.61% respectively for the period from 1997 to 2006, and -7.49% and -3.39% respectively for the period from 2006 to 2023. Liver cancer mortality rate has decreased in younger and older patients, with an APC of -2.53% for younger patients and -0.13% for older patients in the period from 1997 to 2015, and -2.43% respectively for the period from 2015 to 2023. Conclusions: This study shows an increase in mortality rates of colorectal cancer among young adults that almost doubles the rate increase in older adults in Chile. Efforts to raise awareness and improve access to early detection and healthcare should be prioritized.

Distinct Circulating Genomic Features of Classical Hodgkin Lymphoma of Older Adults

Head and neck cancer (HNC) represents a heterogeneous group of tumours requiring multimodality approaches. It is debatable whether HNC treatment in geriatric patients should be different to that delivered for younger patients. Furthermore, the risk of death seems to be higher in HNC patients with higher co-morbidity status. Despite the fact that there is no significant difference in outcome in younger versus older patients, older HNC patients are more likely to receive nonstandard, less aggressive therapies than younger patients. Age alone should not be the basis for selecting treatment options in older HNC patients. A thorough pretreatment evaluation of co-morbidities should always be performed, and radical surgical options should not be excluded in older HNC patients treated with curative intent, as postoperative complications occur no more frequently in older patients than in younger patients. Locoregional control and disease-free survival in older patients treated with radiation therapy (either with curative intent or in the palliative setting) are comparable to the results seen in younger HNC patients, with the same acute toxicity profile. In patients receiving systemic therapies, special attention must be given to modification of chemotherapy dosages according to renal and hepatic function. Molecular-targeted therapies appear to be very useful in such patients because of their favourable tolerability. In conclusion, once all physiological and biological risk factors have been addressed, a large proportion of geriatric patients can and should be offered the same HNC treatment as is offered to younger patients.

The management of palatally displaced maxillary canines: Considerations and challenges

Introduction/BackgroundDespite being a disease of mainly older women, little is known about the clinical management of older women with vulvar squamous cell carcinoma (VSCC). We evaluated their daily clinical management...