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Superion<sup>&reg;</sup> InterSpinous Spacer for treatment of moderate degenerative lumbar spinal stenosis: durable three-year results of a randomized controlled trial

Superion<sup>&reg;</sup> InterSpinous Spacer for treatment of moderate degenerative lumbar spinal stenosis: durable three-year results of a randomized controlled trial

of subjects aged 45 years or older suffering from moderate symptoms of intermittent neurogenic claudication, secondary to a confirmed diagnosis of moderate degenerative lumbar spinal stenosis at one or two contiguous levels from L1 to L5. Patients were treated between June 2008 and December 2011 at 31 investigational sites. Three hundred ninety-one subjects were included in the randomized study group consisting of 190 Superion ® ISS and 201 X-STOP ® control subjects. FDA

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Early menopause and severity of rheumatoid arthritis in women older than 45 years

Early menopause and severity of rheumatoid arthritis in women older than 45 years

Barrett et al. [36] suggested that breastfeeding is a risk factor for a more-severe inflammatory polyarthritis in a small group of genetically susceptible women, based on the linkage between HLA-DRB1 alleles and the prolactin gene on chromosome 6 [37]. In a prospective short-term study of pregnant women with inflammatory polyarthri- tis, they found that women who breastfed after a first pregnancy had a more-severe disease 6 months postpar- tum compared with non-breastfeeders and previous breastfeeders [36]. However, in the present study, we could not demonstrate any significant long-term effect of breastfeeding on the severity of RA. Our study design excludes the smaller group of women who develop RA during their younger years, which could affect our results. The immune-stimulating effect of prolactin could also be short term, and breastfeeding could have a different long-term immune-modulating effect, sug- gested by the results from the Nurses Health Study [38] and our previous results [2].
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Predictive factors of ovarian carcinoma for women with ovarian endometrioma aged 45 years and older in China

Predictive factors of ovarian carcinoma for women with ovarian endometrioma aged 45 years and older in China

In present study, the total prevalence of EAOC in pa- tients with ovarian endometriosis was 2.9%, which was higher than that in previous reports on women at either all ages or over 45 years (0.3–1.7%) [6, 9, 24]. This discrep- ancy might be owing to the different inclusion criteria ei- ther for endometriosis or EAOC within the studies. The diagnosis of all subjects chosen in this study were con- firmed by both surgery and histology, unlike some studies which were based on ultrasound finding, patients’ symp- toms, even retrospective self-report. On the other hand, EAOC group in this study was defined as the coexistence of endometriosis and the malignant tumor in the same or the contralateral ovary, but not critically alliance to Scott’s criteria, although 56.7% of our patients in EAOC group met the latter standard. The comparatively strict inclusion standard of endometriosis and the probably wider diag- nostic criteria of EAOC might lead to a higher prevalence of ovarian cancer related endometriosis. Lee et al. had also demonstrated that the risk of EOC of women with endo- metriosis varies greatly with different diagnostic criteria, and a bias of selected subjects might significantly influ- ence the risk estimation [13, 14]. Because lacking of pre- cise and non-invasive diagnostic tool, studying the risk of cancer among patients with endometriosis whose diag- nose had been surgical-pathologically defined might be more valuable to help us to make clinical strategy at this moment.
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TRANSESOPHAGEAL ECHO STUDY IN PATIENTS WITH ACUTE ISCHEMIC STROKE

TRANSESOPHAGEAL ECHO STUDY IN PATIENTS WITH ACUTE ISCHEMIC STROKE

Patient and methods: The study was conducted in Zagazig university hospitals and included 100 patients diagnosed with ischemic stroke The diagnosis of stroke was made based on clinical data and brain CT. A full TEE was done and the presence of the following potential sources of embolism was specifically examined (a)left atrial spontaneous echo contrast and thrombus , (b)Impaired Left atrial appendage velocity and the presence of LAA (Left atrial appendage )thrombi , (c)Atheroma in the thoracic aorta, (d)Patent foramen ovale and atrial septal aneurysm (e) others, including valvular vegetations and intracardiac masses . Results:Among the different age groups studied , the prevalence of PFO and MVP (mitral valve prolapse) were highest in patients ˂ 45 years old while the prevalence of complex aortic atheroma was highest in patients ˃45 years old .Risk of stroke recurrence was highest in patients with complex aortic atheroma .Among patients with dyslipidemia,prevalance of ischemic stroke was highest in those older than 45 years old and was significantly higher in low HDL (high density lipoprotein ) (˂40 mg/dl ) and high cholesterol (˃200 mg/dl) group.Furthermore, the risk of stroke recurrence was significantly higher in patients with hypercholesterolemia.
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The Most Commonly Occurring Papillary Thyroid Cancer in the United States Is Now a Microcarcinoma in a Patient Older than 45 Years

The Most Commonly Occurring Papillary Thyroid Cancer in the United States Is Now a Microcarcinoma in a Patient Older than 45 Years

This study demonstrates the changing age demographic of PTC patients in the United States over the past 30 years. Several studies have demonstrated the increasing incidence of all types of thyroid cancer based on population database analyses (2–4). Patient demographics and tumor characteris- tics have also been further evaluated using these datasets (5,12,13). To our knowledge, no other study has demonstrated the important shift in age group that has occurred in con- junction with the exponential growth of PTC incidence over the past three decades in the United States. These trends are not due to the aging of SEER population, as the distribution of patient age has remained constant since the inception of the program in 1973 (14). The majority of patients with PTC are now older than 45 years, which has important implications for prognosis and adjuvant treatment as reflected by the key role that age plays in the AJCC staging system for differentiated thyroid cancer. In the 1980s the majority of PTC cases occurred in patients in their late 20s and early 30s; thus, the majority of patients with PTC could only be classified as stage I or II by the AJCC system. However, by 2006 patients in their late 40s and early 50s had the highest rates of PTC, meaning that more patients with larger tumors, lymph node involve- ment, or metastatic disease would be classified as stage III or
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The Older Finnish Twin Cohort — 45 Years of Follow-up

The Older Finnish Twin Cohort — 45 Years of Follow-up

In the 2013 review (Kaprio, 2013), the mailed survey conducted among twins born in 1945–1957 was described in detail. In brief, the questionnaire had 85 questions (and 240 items). The topics covered items about contact with their co-twin, health and risk fac- tors (blood pressure [BP] and cholesterol measurements, diabetes, breathlessness, back pain, bruxism, chronic diseases and use of common medications). Women were asked about hormone replacement therapy (HRT) use. Six questions on sleep were included. Eight items on work and pension intentions were asked next. Twelve questions asked a detailed smoking history, including two nicotine dependence scales, while seven questions were directed to alcohol quantity, frequency and problem drinking. Six items asked about leisure-time physical activity (LTPA) and sedentary behavior. Life events and traumatic experiences in child- hood and adulthood were questioned, as well as items on social interactions. We repeated the four-item life satisfaction scale, and the brief assessment of extraversion and neuroticism (19 items together) asked in previous surveys. We included the CES-D depression scale. Finally, we asked about their current height and weight, as well as weight from 1 year and 5 years earlier, as well as their weight at age 50 and largest weight ever. Finally, the participants were asked to self-measure their waist circumfer- ence with a tape measure included with the questionnaire. We found that this had acceptably high validity when measured by health professionals in the Epigenetics of Hypertension study (Tuomela et al., in press). This has enabled longitudinal analyses spanning up to four measurements and 35 years of follow-up (see below for more detail on analyses related to alcohol, weight and physical inactivity). The details of the three subsets of wave 4 are also shown in Table 1, while Figure 1 gives the numbers of twins who have answered various combinations of surveys, which helps when planning longitudinal analyses.
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Vitrectomy in patients 85 years of age and older: surgical outcomes and visual prognosis

Vitrectomy in patients 85 years of age and older: surgical outcomes and visual prognosis

Results: Mean follow-up was 7.25 months (±5.35), with a range of 1–28 months. General anesthesia was used in 63% of the operations. The most common indication was retinal detach- ment (27%). The ocular condition necessitating PPV was secondary to trauma (most commonly after a fall) in 10 eyes (12%). Mean visual acuity (VA) improved from 1/58 preoperatively to 1/29 at the final evaluation (p=0.014). Mean improvement in VA in eyes of patients with the comorbidity of age-related macular degeneration (n=34) was 41% lower compared to eyes of patients without the disease (n=48, p=0.013). In the subgroup of patients operated on for retinal detachment, 45.4% did not reach primary anatomic success and 45.4% needed additional retina- affecting surgery. One or more major ocular complications were reported in 24 eyes (29%), while 19 eyes (23%) had minor ocular complications.
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Ghrelin Regulates Energy Homeostasis Through Discrete Central and Peripheral Signaling Mechanisms

Ghrelin Regulates Energy Homeostasis Through Discrete Central and Peripheral Signaling Mechanisms

  Age:  The  United  States  is  an  aging  population.  The  number  of  people  ages  65  years  and   older  has  steadily  increased  since  the  1960s 18 .  In  2014,  there  were  46  million  people  ages  65   years  and  older  living  in  the  United  States  and  is  projected  to  double  by  the  year  2060. 18  With   this  said,  the  risk  for  developing  diabetes  increases  with  age. 19   Older  adults  may  be  at  a  higher   risk  because  their  metabolism  slows  down,  functionality  decreases,  and  body  composition   changes. 20  Type  2  diabetes  generally  occurs  after  the  age  of  45  years. 17  According  to  the  2017   National  Diabetes  Statistics  Report,  approximately  355,000  new  cases  of  diabetes  in  2015  were   among  adults  aged  45-­‐64  years. 21  The  average  age  of  T2DM  onset  is  60  years  of  age  with  a   prevalence  rate  of  15%  among  people  over  65  years  of  age.   22  
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Role of zoledronic acid in the prevention and treatment of osteoporosis

Role of zoledronic acid in the prevention and treatment of osteoporosis

IV Zol also significantly reduced the risk of new hip fractures by 41% at 3 years compared with placebo in the overall patient population (stratum 1 and 2) (Table 2). The hip fracture event rate was 1.45% for Zol-treated patients and 2.5% for placebo-treated patients. According to the monograph, the reductions in vertebral and hip fractures over 3 years were consistent and significantly reduced independent of age, number of vertebral fractures at baseline, geographical region, race, baseline body mass index, femoral neck BMD T-score, or prior use of bisphosphonates. Specifically, in patients aged 75 years and older, Zol-treated patients had a 60% decrease in RRR for vertebral fractures compared with placebo patients (P , 0.0001). IV Zol 5 mg once yearly was also effective in reducing the risk of all secondary endpoints such as clinical vertebral fractures (RRR of 77%), any clinical fracture (RRR of 33%), and nonvertebral fracture (RRR of 25%) in the overall patient population ( stratum 1 and 2) during the 3-year treatment period (Table 2). The risk of multiple morphometric vertebral fractures was also significantly reduced by 89% when compared with placebo (0.2% vs 2.3% of patients) in patients without any concomitant osteoporosis treatment (stratum 1).
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Cognitive processing of cluster headache patients: evidence from event-related potentials

Cognitive processing of cluster headache patients: evidence from event-related potentials

We recruited 17 cluster patients (15 males; mean age, 35.4 years; range, 20–45 years) from the Chinese PLA General Hospital according to the diagnostic criteria of the International Classification of Headache Disorders (3rd ed., beta version; ICHD-3 beta). The CH duration among patients ranged from 5 to 15 years, and the clus- ter period ranged from 1 to 6 months. The frequency of CH attacks during previous cluster periods was 1–3 at- tacks per day. Patients were not receiving prophylactic therapy, were drug-free for at least 24 hours, and were in bout but not in headache when recruited. We also re- cruited 15 healthy age-matched participants (13 males; mean age, 34.6 years; range, 22–43 years) with no his- tory of headache or drug/alcohol abuse. Patients and controls had normal or corrected-to-normal vision and normal hearing capabilities. No participants had notable motor or sensory dysfunction or deep tendon reflexes. We excluded participants who were illiterate or suffering from depression, stroke, or brain injuries. The study was approved by the Ethical Committee of the Chinese PLA General Hospital in accordance with the ethical principles of the Declaration of Helsinki. All participants provided written and informed consent prior to commencement of the experiment.
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Transmission of cultural capital and status attainment – an analysis of development between 15 and 45 years of age

Transmission of cultural capital and status attainment – an analysis of development between 15 and 45 years of age

Besides reading, available indicators for students aged 15 included particularly music-related activities, namely learning to play a musical instrument and listening to classical music. In a newer DIW (German Institute for Economic Research – Deutsches Institut für Wirtschaftsforschung) study (Hille & Schupp, 2013), it was shown that youth between the ages of eight and 17 who practiced playing musical instruments did better by a quarter of a standard deviation on cognitive language tests than students of the same age lacking this practice, and their average grade was one-sixth of a standard deviation better. Furthermore, they were a quarter of a standard deviation more conscientious and more open, and the probability that they would graduate from a gymnasium (secondary school leading to university study) and want to attend a university was 15% higher than in a comparison group (Hille & Schupp, 2013, p. 23). In this study, a multiplicity of control variables with regard to parents were used and reverse causality was investigated. So far, it appears that, besides reading books, playing musical instruments is a promising indicator for cultural reproduction in educational systems. Listening to classical music serves in this connection as an indicator for high-cultural orientation of young people.
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Original Article Risk factors for early-onset pancreatic cancer patients, and survival analysis

Original Article Risk factors for early-onset pancreatic cancer patients, and survival analysis

Pancreatic ductal adenocarcinoma has the poorest 5-year survival rate of all malignancies [19]. The diagnosis of this cancer is frequently delayed because it generally has a non-specific clinical presentation [20]. The effect of age on the prognosis of this cancer is not well estab- lished [21]. Because of the rarity of this cancer, there is a dearth of survival data on EOPC patients. Duffy published a large retrospective review of 136 patients under the age of 45 years with a diagnosis of pancreatic ductal ade- nocarcinoma; he found that the EOPC patients with stages I-II disease have a favorable prog- nosis. However, patients with stage III-IV EOPC appeared to have a prognosis as grave as that of the NOPC population with stage III-IV pancre- atic cancers. The median survival time of EOPC Table 3. Multivariate Cox regression of factors associated with EOPC patients’ survival (n=156)
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Apoptotic and antioxidative status of sperm in diabetic patients of 25 40 years age group under duration dependent regular and irregular mode of treatment: a comparative approach of proteomic and genomic study

Apoptotic and antioxidative status of sperm in diabetic patients of 25 40 years age group under duration dependent regular and irregular mode of treatment: a comparative approach of proteomic and genomic study

The current study was performed in the Department of Pathology and Department of Gynecology and Obstetrics, ESIC-PGIMSR, ESIC Hospital, Joka, Kolkata, in collaboration with the Department of Bio-Medical Laboratory Science and Management, Vidyasagar University, Midnapore, West Bengal. The present study consists of 450 cases of chronic diabetic under regular treatment and 450 cases of chronic diabetic under irregular treatment with infertility complication in the age of 25 to 40 years. The results were compared with the values of 150 apparently healthy non-diabetic individuals which were in the same age group. Routine spermiological analysis, glycemic study were conducted of all the patients but biochemical analysis, proteonomic and genomic analysis were followed to 15 patients of each subgroups for constraint of funds as chemicals are highly expensive. Such samples were selected randomly from the patient community fulfilling all the criteria. Subjects were the patients who attended for checkups and treatment in the said departments.
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In-Depth Oral Presentations and Oral Communications

In-Depth Oral Presentations and Oral Communications

Introduction The use of synthetic material for ACL reconstruction has been proposed since the early 80’s. High failure rates have been reported in literature, hence this procedure was not popular in the following decade. The LARS synthetic ligament (ligament advanced reinforcement system) is classified as a second generation ligament designed to elimi- nate the most common complications such as the risk of rupture, synovitis and lack of fibroblast repopulation. The aim of this study was to evaluate, at a long-term follow-up (more than 10 years), whether the good results obtained at the short term visits, had been maintained. Materials and methods Thirty-one patients, between 45 and 66 years of age (mean age 56.4 years) were retrospectively enrolled; all had undergone surgery for ACL reconstruction with the LARS synthetic ligament between 2000 and 2004; they have been evaluated clinically, radiographically and using evaluation scores such as Lysholm Score, IKDC, and Tegner Activity Scale. A biomechanical assessment was performed for each patient including gait analysis, stabilometry, isoki- netic evaluation of the muscle of the lower limb and KT-1000. Results The outcome of the follow-up has been encouraging: the average Lysholm score obtained was 96.06, the average IKDC was 90.97. The Tegner Activity Scale decreased from 4.1 (2–9) pre- operatively to a current 5.8 (4–10). Good–excellent results were also obtained at clinical examination and at the biomechanical evaluation. Three of the 31 patients had to undergo further surgery for rupture of the synthetic ligament (one of these bilateral). Synovitis or other major complications were not observed.
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Reasons for substance use in dual diagnosis bipolar disorder and substance use disorders: A qualitative study

Reasons for substance use in dual diagnosis bipolar disorder and substance use disorders: A qualitative study

All patients included in the study were adults with a diagnosis of bipolar 1 disorder and current and/or past alcohol or drug abuse or dependence. Inclusion criteria were: 1. a SCID-DSM-IV diagnosis of bipolar disorder (First et al, 1997); 2. a SCID-DSM- IV diagnosis of substance use disorder (First et al, 1997); 3. 18 years of age or older; 4. willing to give written informed consent. Exclusion criteria were: 1. bipolar disorder secondary to an organic cause; 2. a current DSM-IV mood episode (mania, mixed affective episode, hypomania or major depression) (American Psychiatric Association, 1994). The study had ethics approval from a local research ethics committee and also local institutional research governance approval.
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BMI over the lifecourse and hearing ability at age 45 years: a population based study

BMI over the lifecourse and hearing ability at age 45 years: a population based study

Previous research on anthropometric factors and adult hearing loss has found relationships, in separate studies, to birthweight and contemporary BMI. However no study has examined data on BMI over the life course. This paper uses data from the 1958 British Birth Cohort to examine relationships between BMI (both in childhood and adulthood), changes in BMI between adjacent age waves, and hearing thresholds at 1 kHz and 4 kHz obtained by audiometric examination at age 45 yrs. Body Mass Index (BMI) in adulthood, but not in childhood, was associated with increased hearing threshold levels at both 1 kHz and 4 kHz at age 45yrs. Two further models examine the effect of changes in BMI between successive waves and adult hearing thresholds, firstly adjusting for childhood hearing loss and a range of further childhood factors (including birthweight, family history of hearing loss, mother’s weight, childhood social class) and secondly adjusting in addition for noise, current social class, current systolic blood pressure and diabetes, current smoking and drinking. In the first model, increases in BMI at age intervals throughout the life course, over both childhood and adulthood, were independently associated with increased hearing threshold levels at both frequencies in mid-life, largest relationships being shown at both frequencies to increasing BMI in adolescence and in early adulthood. These relationships generally persisted in the second model, though were reduced more at earlier ages (pre 23 yrs). Noise at work attenuates the relationship between BMI change and mid-life hearing threshold, more so at 4 kHz than at 1 kHz and for BMI change at older ages. The relationship between 1 standard deviation of BMI change between 11 and 16 years, and mid-life hearing threshold was close to one-third that of noise at work (>5yrs vs. none). Future studies should be carried out to determine the mechanisms underlying these relationships and whether these relationships strengthen as the cohort ages further.
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Epstein Barr Virus Related Diffuse Large B Cell Lymphoma of the Elderly: Assessment of Frequency in an Indian Tertiary Care Centre and Comparison of the Morphological Features of the EBER-ISH Positive and EBER-ISH Negative Cases

Epstein Barr Virus Related Diffuse Large B Cell Lymphoma of the Elderly: Assessment of Frequency in an Indian Tertiary Care Centre and Comparison of the Morphological Features of the EBER-ISH Positive and EBER-ISH Negative Cases

was significantly worse in both the older and younger age groups. Further, the older and younger groups showed a similar overall survival and progression free survival with no significant difference between the two groups.(13) This was in contrast to another study by Hong et al who reported that EBV positive DLBCL in young adults was not associated with unfavorable outcomes.(51) An elegant study by Nicolae et al published in 2015 described 46 cases of EBV+DLBCL in patients younger than 45 years of age. They discussed that the EBV+DLBCL in the young resembles those of the elderly in many respects, in that they both expressed a predominant activated B cell or Non Germinal B cell phenotype and had an EBV latency type II. However, in contrast to the elderly type, EBV+DLBCL of the young showed a clinical response to standard treatment protocols and showed a favorable outcome. They also found a higher proportion of nodal disease rather than extranodal disease, which is in contrast to that observed in EBV+DLBCL of the elderly.(52)
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THE EFFECT OF IMMUNIZATION AGAINST INFLUENZA ON AN EPIDEMIC OF RESPIRATORY ILLNESS IN CHILDREN

THE EFFECT OF IMMUNIZATION AGAINST INFLUENZA ON AN EPIDEMIC OF RESPIRATORY ILLNESS IN CHILDREN

unimmunized or control group, with a median age of 8.7 years and an average age of 10 years, was definitely older than the immunized.. group in which the median age was 3.7 years.[r]

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The effect of physical exercise on bone density in middle-aged and older men: A systematic review

The effect of physical exercise on bone density in middle-aged and older men: A systematic review

With the aging of the population, developing safe and effective strategies to prevent osteoporosis and consequent fractures is of great importance. The mechanisms that underpin bone mineral density (BMD) decline following peak bone mass are multifaceted and complex in nature. Although changes in sex hormones, nutrition and bone-loading are responsible for bone loss across the lifespan in males and females, important gender-specific differences exist [1, 2]. The decline in bone mass in men up to the age of 50 and in premenopausal women is approximately 0.3 to 1.1% per year [3], with an accelerated rate of bone loss in women for four to eight years following menopause [4] due to oestrogen withdrawal. During this period, women will lose approximately 15% in BMD or 1 standard deviation (SD), leading to a 1.5-to 3-fold increase in fracture risk [5, 6]. In contrast, the decline in bone mass for men is more gradual with an age-related loss of ~0.7% per year after age 50 [3]. Nonetheless, approximately one third of all osteoporotic fractures are accounted for by middle-aged and older men [7] and so understanding the role preventative strategies (for example exercise) may have in attenuating the bone loss experienced by men in this age group is of great importance.
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Schooling Performance Outcomes after Elective Tonsillectomy in Children: A Review Article

Schooling Performance Outcomes after Elective Tonsillectomy in Children: A Review Article

In recent years, there has been increasing economic and demographic development in developing countries resulting in a shift from diseases caused by poverty toward chronic, non- communicable and lifestyle-related. This happening in the younger age group adds to the social burden, and as such these patients merit special attention in diagnostic, therapeutic, and preventive care. 4 It leaves the patients with residual disabilities like physical

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