Permanent atrial fibrillation (pAF) is a serious concomitant problem in many patients undergoing open heart surgery, particularly in those with advanced age: a prospective analysis among 4590 patients, which were scheduled for open heart surgery in our institution between February 2001 and December 2004, revealed a prevalence of pAF (persisting for at least 6 months) of 4.6% in older aged patients (70-99 years), compared to only 2.9% in young patients (p<0.001; Table 1.); the prevalence was particularly high in elderly women (7.2% [58 of 809], compared to 3.1% [43 of 1381] in older aged men; p<0.001).
Our study is novel in comparing the characteristics of positive-interaction parenting style among three age groups of mothers in Canada using a nation-wide dataset. All mothers reported similar levels of positive-interaction parenting however, unique characteristics associated with parenting were present. There were no common variables significant with parenting across the three groups how- ever; mother’s perceived health was the most thought- provoking finding in our study. Very good/excellent health predicted positive-interaction parenting differently for teen and advanced age mothers, advising readers to be mindful that maternal health may be an important con- tributor to parenting, albeit its effect size of 0.20 noted in our results. The key to better understanding this relation- ship may lie within conducting further research with ad- vanced age mothers as this area is still in its infancy. Our findings may have strong public health implications through information dissemination to first-time mothers, clinicians, researchers, and public health facilities. Target- ing these audiences with information on how perceived health may impact parenting differently based on maternal age may be one strategy to increase awareness. Further, the implications of this study may help the academic com- munity to foster partnerships with policy-making bodies to inform evidence-based recommendations specific to health status and positive-interaction parenting.
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When discussing consequences of advanced maternal and paternal age, it is often argued that adverse health outcomes should be weighed up against potential social advantages for the children, because the parents are more likely to have progressed in their careers and to have financial security [7,8]. While this may be true for most children of older parents, our recent findings in a study of the characteristics of older first-time mothers suggest that the picture is more complex . In addition to having more age-related reproductive and physical health problems, women of advanced age constituted a heterogeneous group characterised by either socioeco- nomic prosperity or vulnerability. On the one hand, high maternal age was associated with high annual income; and on the other hand with a low level of education, sin- gle status, unemployment, an unsatisfactory partner rela- tionship and an unplanned pregnancy.
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One of the main global problems is the aging of society which is supposed to be a combined result of low fertility, low immigration, and prolonged lifespan. 1,2 In order to tackle this issue it is necessary to learn more about aging at the biochemical and molecular levels, as well as about the biological, medical, and social conse- quences of this process. A 30-year gain in life expectancy has been recorded in highly developed countries during the 20 th century. 2 – 4 This tendency has also been noticeable in Poland since 1990. According to the projection of Polish Central Statistical Of ﬁ ce, the life expectancy in Poland may increase from 70.0 years in 2007 to 77.1 years in 2035 for males and from 79.7 – 82.9 for females, respectively. In this period of time, the percentage of Polish population at post-working age (60+ years for women and 65+ years for men) may change from 16% – 26.7%.
RESULTS: Cerebral microbleed prevalence was similar in subjects with mild cognitive impairment and controls with stable and cognitively deteriorating conditions (25%–31.9%). In all diagnostic groups, lobar cerebral microbleeds were more common. They occurred in 20.1% of all cases compared with 6.5% of cases with deep cerebral microbleeds. None of the investigated variables (age, sex, microbleed number, location and depth, baseline Mini-Mental State Examination score, and the Fazekas score) were signiﬁcantly associated with cognitive deterioration with the exception of education of ⬎ 12 years showing a slight but signiﬁcant protective effect (OR, 0.44; 95% CI, 0.22– 0.92; P ⫽ .028). The Mini-Mental State Examination and the Buschke total score were correlated with neither the total number nor lobar-versus- deep location of cerebral microbleeds.
Several studies investigating the impact of advanced age on pregnancy outcomes [7–9] produced conflicting results because of differences in study group homogen- eity and inadequate control for variables like maternal diseases, assisted conception, obesity, multiple pregnan- cies, and parity. The results of this study, in which all of these variables were controlled for, demonstrate that advanced maternal age nulliparous women with no pre- vious chronic diseases, including obesity, there is an increased odds of adverse perinatal and neonatal out- comes, including gestational diabetes, gestational hyper- tension, preeclampsia, SGA, spontaneous late preterm delivery between 34 and 37 weeks of gestation, and cesarean delivery, but not spontaneous preterm delivery before 34 weeks, ablatio placentae, prolonged rupture of membranes, placenta previa, LGA, and operative vaginal delivery. These evidence-based conclusions should be of interest to both advanced maternal age women and medical professionals. Consistently with the current results, Khalil et al. demonstrated that preeclampsia, SGA, GDM, and cesarean delivery were more common in advanced maternal age pregnancies. However, they Table 1 Patient characteristics
Nonetheless, we acknowledge several limitations of our study. First, data on conception method were from records at the delivery hospitals, which in some cases could have been based on self-report from the mother, leading to underreporting of ART usage. Although pre- vious studies demonstrated high positive predictive value of self-reported conception method on actual method, we cannot exclude the possibility of misclassification bias [38, 39]. Second, because our database was based on tertiary hospitals, our study population likely com- prised a higher proportion of high risk pregnancies leading to potential underestimation of the effect of advanced age on adverse outcomes compared to the general population. To reduce this bias, we excluded women with higher risk such as multiple pregnancy, fetal anomaly; maternal characteristics associated with advanced age pregnancies and risk of adverse pregnancy outcomes were adjusted for in the multivariate analysis, such as preexisting hypertension and abnormal glucose tolerance. Furthermore, we confirmed that our results did not change after adjusting for institution (data not shown). However, further population-based studies should be performed for replication and to clarify the generalizability of our findings. Third, while oocyte donation is one method for conception more popular among women of very advanced age,  and women who conceived by oocyte donation are reported to have higher risk of adverse birth outcomes,  our database did not include information on the type of ART. As
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Purpose: The study aimed to show differences in tem- poral recovery of pelvic floor function within 6 months postpartum between women having their first deliv- ery at an advanced age and those having their first delivery at a younger age. Methods: Seventeen wo- men (age: 35.5 ± 3.5, BMI: 21.1 ± 3.2) were studied at about 6 weeks, 3 months, and 6 months after vaginal delivery. Urinary incontinence was assessed by the International Consultation on Incontinence Question- naire-Short Form. Pelvic floor function was assessed by the anteroposterior diameter of the levator hiatus using transperineal ultrasound. Women who deliv- ered for the first time at 35 years and/or older were defined as being of advanced maternal age. Results: Nine of 17 women (52.9%) were of advanced mater- nal age and 5 experienced postpartum stress urinary incontinence. Four of these 5 women (80.0%) were of advanced maternal age. The anteroposterior diame- ter of the levator hiatus at rest was significantly grea- ter in the advanced maternal age women than in the younger maternal age women at 3 and 6 months post- partum (p < 0.01). Among the continent women, the anteroposterior diameter of the levator hiatus at rest was significantly greater in the advanced maternal age women than in the younger maternal age women at 6 months postpartum (p = 0.004). However, among the advanced maternal age women, all parameters of the anteroposterior diameter of the levator hiatus were not significantly different between the women with and without stress urinary continence. Conclu- sion: Recovery of pelvic floor function following de- livery may be delayed in women of advanced mater-
proposed criteria would apply to all individuals, including psychiatric patients. In more detail, these authors identi- fied twelve crucial criteria concerning BIID (or apotem- nophilia): age at onset, advanced age at desire, disclosure to family and doctors, predominantly male gender, no predefined sexual orientation, association with gender identity disorder and/or other paraphilia, no psychiatric family history, no predominant laterality for amputation, association with a history of exposition to other amputees during childhood, no association with trauma or sensory impairments of the limb to be amputated, self-amputation behaviors, possible association with personality disorders, and treatment with antidepressant and cognitive behavioral therapies. It can be noticed immediately that while these criteria fit nicely with the case reports reviewed, they might not be suitable for other cases described (see Neurologic etiology section below). First and Fisher 5 tried to solve
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hypotension may be associated with decreased peripheral tissue perfusion. It is worth noting that hypertensive patients suffering from comorbid chronic diseases are often treated with antihypertensive agents despite very low blood pres- sure in the context of advanced chronic diseases. Multivari- ate logistic regression analysis also allowed identification of five other factors assessed during hospitalization and associated with the pressure ulcer formation. We observed
considerations before permission is granted, prioritizing a finite resource (donated oocytes) for a procedure which is costly and has a low success rate, and further assessment of the ethics of egg donation in all age groups. Furthermore, transparent guidelines must consider social and medical factors such as culture, religion, life expectancy, quality of medical care and antenatal management that should be implemented. Further, PMW should be denied IVF if they are deemed physiologically or psychologically unable to cope with a pregnancy.
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A solid-phase aminophenyl boronic acid (APB)-ELISA  was used to measure the IgG-AGE in the high-molecular- weight complexes, which were isolated from serum by a polyethylene glycol precipitation method. Sera were made to a 2.5% final concentration with polyethylene glycol 8000 and incubated for 16 hours at 4°C. After centrifuga- tion at 13 000 g for 15 min, the supernatant was discarded and the precipitate was resuspended back to the original serum volume with phosphate-buffered saline (PBS). The IgG-AGE was measured by ELISA of the AGE proteins that were captured via cis-diols to the solid-phase immobi- lized APB. APB (Sigma, Oakville, Ontario, Canada) 2 mg/ml in 0.2 mol/l carbonate/bicarbonate buffer (pH 9.4) was reacted with Reacti-Bind maleic anhydride activated polystyrene 96-well plates (Pierce, Rockford, IL, USA) for 16 hours at 37°C. Plates were washed with EPPS buffer (0.15 mol/l NaCl, 0.02 mol/l EPPS [Sigma], and 0.01 mol/l MgCl 2 ; pH 8.6) three times. The test samples (100 µ l) from the 2.5% polyethylene glycol precipitate (diluted 1/500–1/4000 as necessary to keep the values within the standard curve), positive and negative controls, and an appropriate standard curve using IgG 1 -AGE (0.625–10 µ g/ml), all diluted in EPPS buffer and in dupli- cate, were incubated for 1 hour at 37°C. After washing the plates three times with PBS/0.1% Tween 20, the plates were blocked with 100 µ l 1% goat serum in PBS/Tween 20 for 1 hour at 37°C. The plates were washed three times with PBS/Tween 20.
There is accumulating evidence to show the active par- ticipation of renin-angiotensin system (RAS) in DN as well . Indeed, inhibition of RAS by angiotensin- converting enzyme (ACE) inhibitor or angiotensin II (Ang II) type-1 receptor (AT1R) blocker has been shown to suppress the development and progression of ne- phropathy in both type-1 and type-2 diabetic subjects [25,26]. Further, losartan, an AT1R blocker, improves renal outcome in patients with type-2 diabetes . Moreover, we have previously found that RAS blockers could inhibit the AGE-elicited mesangial cell hyper- trophy, proximal tubular cell injury, and podocyte DNA damage and detachment in vitro [28-30]. However, the involvement of AGE and RAS in MMP-2 activation in DN remains unknown. Therefore, we first examined the effects of ramipril, an inhibitor of ACE on MMP-2 activ- ity, AGE and RAGE expression in renal tubules of strepto- zotocin (STZ)-induced diabetic rats. Then we investigated whether AGE injection could stimulate RAGE gene ex- pression and MMP-2 activity in tublules of normal non- diabetic rats. We further studied the effects of ramiprilat, an active metabolite of ramipril, on MMP-2 activity and re- active oxygen species (ROS) generation in AGE-exposed rat renal proximal tubular cells (RPTCs).
Multiple births account for 3% of all births worldwide (Pharoah et al., 2010). Globally, recent decades have seen a major increase in multiple births rates (Martin et al., 2012; Pison & D’Addato, 2006). From 1980 to 2009 in the United States, the number of twins has doubled and the twinning rate has risen by more than 75% (Collins, 2007). Similar increasing trends have also been observed in Western Eu- rope and other countries (Pison & D’Addato, 2006). Older maternal age accounts for about one third of the growth in the twinning rate, and the increased use of infertility treat- ments is likely to explain much of the remainder of the rise (Martin et al., 2012).
A further point of difference between Snay and Sophy was the significantly higher levels of violence recorded at Snay (23.4% with cranial trauma compared with only 2.8% at Sophy) (Domett et al., 2011; Domett, pers.comm.). During the development and later establishment of the strongly hierarchical Angkorian state (c. A.D. 800), local control over resources, including water and agricultural land, and commodities for exchange including salt and fish, is likely (Domett et al., 2011; O’Reilly et al., 2006) and may have lead to intercommunity violence. Subsistence practices at Snay may have been affected by the greater social tension in this community and as a result, procurement territories may have been restricted. However, archaeological evidence does indicate a large number and range of wild and domesticated species were available at Snay (O’Reilly et al., 2006). The sample from Sophy is from the later in the Iron Age (AD 100-600) compared with Snay (350 BC to AD 200) and perhaps socio- political changes were now in place with increased control and less violence. Additionally, Sophy is approximately 40kms west of Snay, further from the eventual centre of the Angkorian polity, and may have been less exposed to its influences. However both Sophy and Snay were on the ancient road to Angkor, between the expansion of Angkorian influence in northeast Thailand and the city of Angkor in northwest Cambodia.
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In June 1998 in the House of Commons, Labour backbencher Ann Keen tabled an amendment (new clause 1) to the Crime and Disorder Bill which advocated the reduction of the age of consent for sex between men from 18 to 16 – the same as the age of consent between a man and a woman. In the House of Commons the clause was overwhelmingly supported (336 to 129). A month later in the House of Lords, the decision was reversed – again by an overwhelming majority (290 to 122). In 1999, a revised version of the amendment, in the form of the Sexual Offences (Amendment) Bill, was tabled and supported in the House of Commons (313 to 130) but opposed in the House of Lords (222 to 146). Consequently, the British law continued to maintain a different age of consent for sex between males compared with that for heterosexual sex. Finally, in November 2000 (the 100th anniversary of the death of Oscar Wilde,
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Normal distributions were expressed as mean with SD. Continuous variables with skewed distributions were expressed as median with interquartile range (IQR). Cat- egorical variables were expressed as proportions and percentages. Differences in continuous variables between groups were tested with the Mann-Whitney U test. Dif- ferences in categorical variables between groups were tested by the chi-squared test or Fisher’s exact test. Correlations were tested with Pearson’s rho in case of nor- mal distribution and Spearman’s rho in case of skewed distribution. Patients with type 1 diabetes and controls were stratified into multiple age categories (11–12, 13–14, 15–16, and 17–19 years). For each age category, patients were stratified according to HbA1c-above-target and Hba1c-within-target. For both patients with HbA1c- above-target and Hba1c-within-target, SAF was descrip- tively compared with SAF of controls.
Despite the evidence for health effects, less is known of the potential fitness consequences of the increase in the number of mutations with paternal age. Paternal age at birth is often associ- ated with child health, and indirect evidence suggests that much of this effect may be due to in- creased mutation load. For example, increased father ’ s age is a risk factor for schizophrenia [16,17], autism spectrum disorder [3,16,18–23], and multiple other genetic disorders [24–27], although not for general cognitive ability . Moreover, increased paternal age is associated with reduced Darwinian fitness, largely through its negative association with survival. For in- stance, increased paternal age was associated with lower life expectancy of daughters in the Eu- ropean royal and noble families [29,30] and in German village genealogies of 15th–early 20th centuries ; it was also associated with higher mortality of children in contemporary Euro- pean cohorts [32–34]. Lastly, a paternal age of over 70 years was associated with lower child survival in the Utah Population Database . However, studies of French  and American  cohorts of centenarians born in the late 19th century found that they did not have younger fathers than the population average. In addition, a study of a contemporary Canadian popula- tion showed that parental age had no effect on frailty and survivorship of the elderly , sug- gesting that most of the paternal age effect is expressed relatively early in life.
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Abstract: Objective: To compare obstetric outcomes among women at advanced maternal age in relation to another group of 20 to 29 years. Methods: this is an observational descriptive study. Women of advanced maternal age were 40 and older at the first pregnant control (N = 154). The control group were pregnant women between 20 and 29 years (N = 3900). Odds ratio (CI 95%), mean and standard deviation, median and Fisher exact test were used to compare. Results: The rate of chronic hypertension, preeclampsia, diabetes, and bleeding were higher in the study group when compared with the control group. The rate of caesarean sections (due to a great number of elective ones), preterm delivery <37 weeks and lower birth weight (< 2500g) were also higher in the study group. Conclusion: women at advanced maternal age have an increased risk of adverse outcomes during pregnancy and delivery compared to pregnant women between 20 and 29 years. This electronic document is a “live” template. The various components of your paper [title, text, heads, etc.] are already defined on the style sheet, as illustrated by the portions given in this document.
surveillance and special effort should be made in those pa- tients to prevent complications. In our population, some obstetric risks such as GD and c-section in women be- tween 35 and 39 years were higher than in the reference group but not clinically relevant enough (considering relevant an OR ≥ 2 for the variables studied). Moreover, important outcomes such as placenta previa showed no association with this group of age. In women ≥40 years, significantly higher risks were observed, especially regard- ing GD (aOR 2.91), PP (aOR 2.56) and c-section (aOR 2.45). Special attention should be focused on women ≥45 years, as it is the group with the highest risks: 19.3% inci- dence of GD, 6.1% of placenta previa, 71.8% of c-section (including higher risk of emergency c-section), 2.1% of prolonged maternal hospitalization, 6.1% of iatrogenic prematurity < 37 weeks (AdjOR 2.62) and 2.9% of PPROM (OR 3.38). In our population, a definition of AMA above 35 years could dilute obstetric risks and medical efforts on surveillance, and a definition above 45 years could miss many patients at increased risk of relevant adverse obstet- ric outcomes. Thus, with the information obtained in this study, we propose a cut-off to define AMA ≥40 years for our population.
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