Search Results (912)

Diabetes mellitus affects an estimated 589 million adults globally, and cutaneous manifestations occur in up to 70% of affected individuals during the course of the disease. The objective of this narrative review is to examine the intersection of diabetes mellitus, skin aging, cosmetic dermatologic procedures, and regenerative therapies, with an emphasis on evidence-based best practices and clinical considerations. While the impaired wound healing associated with diabetes has been extensively studied, the aesthetic implications of diabetic skin disease remain comparatively underexplored. Individuals with diabetes frequently exhibit features of accelerated cutaneous aging, including premature wrinkling, dyschromia, xerosis, alopecia, and other cosmetically significant dermatoses that may negatively impact quality of life. In parallel, the demand for aesthetic dermatologic procedures among patients with diabetes has increased substantially; however, evidence-based recommendations guiding the safe and effective use of cosmetic interventions in this population remain limited. Diabetic skin demonstrates accelerated biological aging driven by complex pathophysiological mechanisms, including the accumulation of advanced glycation end products, chronic low-grade inflammation, oxidative stress, microvascular dysfunction, and neuropathy. These processes partially overlap with chronological aging and photoaging but are mechanistically distinct and may influence tissue repair, inflammatory responses, and the safety profile of commonly performed aesthetic procedures such as chemical peels, laser resurfacing, dermal fillers, neuromodulators, and microneedling. Emerging regenerative approaches, including platelet-rich plasma, platelet lysate, and mesenchymal stromal cell-derived products such as exosomes and secretomes, have attracted increasing attention as biologically targeted strategies for cutaneous rejuvenation. Nevertheless, clinical evidence specifically addressing aesthetic interventions in diabetic populations remains limited. A diabetes-informed approach to aesthetic dermatology that considers metabolic status, procedure selection, and post-procedural monitoring is therefore essential to optimize safety and therapeutic outcomes. Full article

The transjugular intrahepatic portosystemic shunt (TIPS) is a cornerstone intervention for complications of portal hypertension, including variceal bleeding and refractory ascites. As the population with cirrhosis ages, clinicians increasingly face the question of whether and how to perform TIPS safely in older adults. We reviewed observational cohorts, registry analyses, and systematic reviews/meta-analyses. Existing evidence does not support chronological age as an absolute contraindication; however, multiple studies suggest that advanced age is associated with higher rates of post-TIPS hepatic encephalopathy (HE), early mortality, and readmissions. These findings underscore the need to shift from a binary “eligible vs. ineligible” paradigm to a structured, actionable framework that addresses modifiable risks and anticipates age-related vulnerabilities. Recent clinical practice guidance emphasizes comprehensive pre-TIPS assessment and vigilant post-procedure care, with specific attention to HE risk factors (e.g., prior HE, hyponatremia, renal dysfunction, sarcopenia) and cardiopulmonary reserve. In this narrative review, we propose an elderly-focused clinical pathway built around a four-domain assessment (Liver–Brain–Body–Heart/Kidney) and a traffic-light risk tiering system to guide patient selection, procedural strategy, follow-up scheduling, and triggered management of HE, cardiac decompensation, and renal dysfunction. This pathway aims to preserve the benefits of portal decompression while reducing preventable complications and improving outcomes that are meaningful to older patients, including functional status and quality of life. This narrative review emphasizes that outcomes after TIPS in older adults are determined not by chronological age alone but by multidomain physiological reserve. The proposed pathway informs patient selection, procedural planning, and early post-discharge monitoring in older adults. Full article

Objectives: Cardiovascular diseases (CVDs) represent the main global burden of morbidity and mortality, with an accelerated epidemiological transition in regions such as Latin America. The university environment constitutes a period of critical vulnerability due to increased sedentary lifestyles and cardiometabolic risk factors. The objective of this study was to evaluate the cardiovascular risk profile in a university community in the central Andean region of Colombia using anthropometric, haemodynamic and biochemical indicators. Methods: A cross-sectional, observational, and analytical study was conducted on a sample of n = 143 participants (students, teachers, and administrators) aged between 18 and 80 years. Haemodynamic parameters (SBP, DBP, MAP), anthropometric parameters (BMI, % body fat, waist-to-height ratio [WC/W]) and lipid profile were evaluated. Statistical analysis included multiple linear regression models to determine predictors of systolic blood pressure (SBP). Results: Significantly higher levels of SBP were found in the older age groups compared with the younger age groups, reaching stage 1 hypertension levels in the sixth decade. The biochemical profile revealed metabolic deterioration with an atherogenic index (TC/HDL) consistently above the clinical threshold (>4.5) in all groups. The regression model BMI was identified as the statistical predictor with the strongest association with SBP variability in the sample (β = 1.18), followed by age (β = 0.28). A marked sexual dimorphism was observed, with men presenting early haemodynamic risk, while women experienced an accelerated post-menopausal tension and metabolic crisis. Conclusions: The university community presents latent cardiometabolic vulnerability closely linked to modifiable anthropometric factors. These findings underscore the urgency of implementing institutional preventive health policies and weight control intervention programmes to mitigate the future burden of chronic diseases on campus. Full article

Background: As life expectancy increases, a growing number of elderly patients are considered for curative hepatectomy for hepatocellular carcinoma (HCC). However, perioperative outcomes in elderly patients in the contemporary era of minimally invasive liver surgery remain incompletely defined. Methods: We retrospectively reviewed 277 consecutive patients who underwent elective curative hepatectomy for HCC between 2019 and 2023. Outcomes were compared using age thresholds of ≥75 and ≥80 years. The primary endpoints were 90-day mortality and major postoperative complications (Clavien–Dindo grade ≥ III). Multivariable logistic regression identified predictors of major complications. Results: Elderly patients had more comorbidities, whereas liver function, tumor characteristics, and extent of resection were comparable across age groups. Laparoscopic hepatectomy was performed more frequently in patients aged ≥80 years. Major complication rates and 90-day mortality were similar regardless of age, with no deaths among patients aged ≥75 or ≥80 years. Age ≥75 years, higher ALBI score, major comorbidities, and longer Pringle maneuver time were independently associated with major postoperative complications. Conclusions: Hepatectomy for hepatocellular carcinoma may be performed with acceptable short-term outcomes in carefully selected elderly patients, including octogenarians. Chronological age alone should not be considered an absolute contraindication to surgery, although findings should be interpreted with caution. Full article

Background/Objectives: Inequality in survival across socioeconomic strata has been growing in the US for decades. Traditional measures of this inequality increasingly fail to capture the heterogeneous biological realities of the US population. Using new measures, this study provides a fresh perspective on the dynamics of mortality inequality across ten socioeconomic deciles in the United States from 1982 to 2019. Methods: The data come from annual life tables from US counties, aggregated according to their socioeconomic characteristics. Measures of Inequality: Three measures of inequality are used, capturing survival inequality from different perspectives, inequality in ages of death over the lifecycle, inequality in survival at older ages, and inequality in survival in midlife. For the latter, the equal survivorship age (ESA)—a metric defined as the age at which a specific subgroup’s survival probability from age 20 matches the survival probability from age 20 to 65 of the total population—is used. Results: We find consistently growing inequality, largely unaffected by economic circumstances such as the Great Recession. By 2019, the ESA for the lowest socioeconomic decile was nearly 11 years lower than the ESA of the highest decile. Conclusions: This “survival gap” in the ESA suggests that low-socioeconomic status (SES) populations effectively exhaust their survival reserves a decade earlier than their high SES counterparts. These findings challenge the equity of the use of universal chronological ages in public policies and underscore the need for “Social-Determinant-Adjusted” geriatric policy models. The growing inequality in the ESA suggests the importance of cohort-based influences. Full article

Background: Genetic causes of growth failure should be suspected in patients born small for gestational age (SGA) who fail to show postnatal catch-up growth, present with severe short stature (SS), and exhibit a poor or absent response to growth hormone (rhGH) therapy. Mutations in the insulin-like growth factor 1 receptor (IGF1R) gene are associated with impaired growth, intrauterine growth restriction (IUGR), low birth weight and/or length, and postnatal SS. Case Description: A 9-year-old boy, born SGA for birth length, was evaluated for severe SS. Common causes of SS were excluded. At 9 years and 7 months of age, his height was 112.6 cm (−3.99 SDS), weight 18 kg (−3.79 SDS), and BMI 14.2 kg/m² (−1.8 SDS); pubertal development was Tanner stage 1. The target height was 158 cm (−2.62 SDS). Bone age was delayed by approximately one year compared with chronological age. Serum IGF-1 levels were within the upper-normal range for age. GH therapy (0.035 mg/kg/day) was initiated due to the lack of catch-up growth in an SGA subject. After three years of treatment, the height gain was only 0.5 SDS. IGF-1 levels showed a transient treatment-related increase, followed by persistent normalization during ongoing therapy. Next-generation sequencing (NGS) analysis identified novel heterozygous paternal nonsense variant in the IGF1R gene: c.3498C>G (p.Tyr1166Ter). At 12 years of age, impaired fasting glucose and reduced glucose tolerance were detected; consequently, it was decided to discontinue rhGH therapy, also in light of the IGF1R mutation and the lack of height recovery. Conclusions: This case underlines the critical role of genetic testing in the evaluation of patients born SGA. The coexistence of SGA status and an IGF1R gene mutation may provide a clear explanation for both the poor response to rhGH therapy and the increased risk of alterations in glucose metabolism. An extensive narrative review of the literature on growth outcomes and glucose metabolism abnormalities during GH treatment in SGA patients carrying IGF1R variants was also performed. Full article

The geochronological framework of the Late Mesozoic volcanic succession in the Great Xing’an Range is crucial for understanding the tectonic regime transition in Northeast Asia. However, the ages and stratigraphic relationships of key volcanic units remain poorly constrained. This study presents zircon LA-ICP-MS U–Pb geochronological data from volcanic rocks above and below the basal unconformity of the Longjiang Formation in the Zhalantun–Jalaid Banner area, central Great Xing’an Range, aiming to determine the timing of volcanic activity, constrain the formation age of the unconformity, and explore its regional tectonic implications. The volcanic–stratigraphic succession in the study area, from base to top, comprises the Baiyingaolao Formation, the basal andesitic conglomerate of the Longjiang Formation, and the Longjiang Formation andesites. Geochronological results indicate that the underlying rhyolitic tuff of the Baiyingaolao Formation yields an age of 130.0 ± 0.1 Ma. Within the andesitic conglomerate overlying the unconformity, andesitic clasts yield an age of 135.8 ± 1.1 Ma, whereas the matrix provides a youngest detrital zircon population age of 130.7 ± 1.0 Ma, constraining the maximum depositional age of the conglomerate. The overlying andesite of the Longjiang Formation gives an eruption age of 125.6 ± 0.8 Ma. These data indicate that the main phase of Longjiang Formation volcanism occurred at ~125.6 Ma, and the basal conglomerate was deposited after ~130.7 Ma. Combined with the ~130 Ma age of the underlying Baiyingaolao Formation and the presence of weathering crusts and erosional surfaces between the two formations, the sedimentary hiatus and exhumation event represented by this unconformity are precisely constrained to have occurred between ~130 Ma and 125.6 Ma. The timing of this unconformity closely coincides with the regional transition in magmatic assemblages from bimodal to andesitic compositions, suggesting that it records a significant tectonic adjustment event in the Great Xing’an Range during the middle to late Early Cretaceous. This finding provides key chronological evidence for understanding the episodic tectonic evolution of Northeast Asia during the Late Mesozoic. Full article

The Jiaodong gold concentration area, one of the most important gold metallogenic belts in China, has long been the focus of contentious debates regarding the genetic mechanisms and timing of gold mineralization. This study presents the new monazite U-Pb and pyrite Rb-Sr isotopic chronology data for the No. I ore zone of the Xidouya gold deposit, integrated with H-O-S isotopic geochemical analyses, to systematically investigate the mineralization age, ore-forming fluid sources and material provenance of the deposit. The main mineralization age of the deposit is constrained to 117 Ma, which is highly consistent with the regional mineralization peak of 120 ± 5 Ma in the Jiaodong gold concentration area. The δD values of the fluids range from −88.0‰ to −75.0‰ (mean = −82.6‰), while the δ¹⁸O_H2O values are calculated to be between 4.6‰ and 6.1‰. H-O isotopic data indicate that the ore-forming fluids of the Xidouya gold deposit originated from a mixed magmatic and meteoric source. As mineralization progressed from Stage I through Stage III, there was a detectable trend of increasing meteoric water involvement and a general decrease in δD and δ¹⁸O_H2O values. This signature indicates that the initial mineralizing system was dominated by primary magmatic water which subsequently underwent significant water–rock interaction with Early Cretaceous granitic bodies and progressive dilution by meteoric fluids in an open tectonic environment. Furthermore, sulfur isotopes (average δ³⁴S = +7.43‰) and the initial strontium isotope ratio (⁸⁷Sr/⁸⁶Sr = 0.71012) support a mixed-source model for the ore-forming materials, likely dominated by the anatexis of ancient crust with potential minor mantle-derived contributions. During the Early Cretaceous, lithospheric thinning and extension in the North China Craton (NCC) triggered large-scale magmatism and mineralization. The Xidouya gold deposit is a direct product of these regional tectono-magmatic-mineralizing events. This study provides new high-precision isotopic dating data for the Xidouya gold deposit, clarifies the evolutionary history of ore-forming fluids and the supply mechanism of ore-forming materials, and provides important theoretical insights and practical references for gold prospecting and exploration in the eastern part of the Jiaodong gold concentration area. Full article

With the increasing prevalence of neurodegenerative diseases driven by population aging, imaging-based biomarkers are needed to quantify brain aging at an early stage. Brain age, which estimates structural brain aging relative to chronological age, has emerged as a useful indicator. Prior work has mainly used T1-weighted MRI with deep learning models such as convolutional neural networks (CNNs) or transformers; however, many approaches insufficiently capture three-dimensional structural continuity and localized anatomical patterns, and tissue-specific aging in gray matter (GM) and white matter (WM) is often treated as auxiliary. To address these limitations, we propose a 3D Global–Patch Transformer framework for brain age prediction that directly processes volumetric data while jointly learning global brain structure and local anatomical features. Our model runs global and patch pathways in parallel and explicitly incorporates GM and WM structural maps alongside T1-weighted MRI to encode tissue-specific aging signals. Experiments on multiple public datasets, including IXI and OASIS, show that the proposed method reduces mean absolute error (MAE) by approximately 10–15% compared with CNN-based and single-input transformer baselines, with notably improved performance in older populations, highlighting the value of tissue-level structural information for brain age estimation. Full article

Biological cardiovascular vulnerability is defined as an imaging-derived construct integrating myocardial functional impairment, coronary microvascular dysfunction, and modeled hemodynamic burden, including global longitudinal strain, coronary flow reserve, and derived vascular indices. To evaluate whether advanced echocardiographic and coronary Doppler imaging parameters identify biological cardiovascular vulnerability associated with the severity and complications of infective endocarditis beyond conventional structural findings. In this retrospective single-center cohort study, we analyzed consecutive patients with definite infective endocarditis who underwent advanced echocardiographic and coronary Doppler imaging. Comprehensive transthoracic and transesophageal echocardiography assessed vegetation characteristics, left ventricular function, global longitudinal strain (GLS), diastolic indices, right ventricular function, and pulmonary artery systolic pressure. Coronary microvascular function was evaluated noninvasively using transthoracic Doppler-derived coronary flow reserve (CFR) of the left anterior descending artery. Associations with disease severity and perivalvular complications were evaluated using multivariable regression analysis. Reduced coronary flow reserve was independently associated with the composite severe infective endocarditis phenotype, as defined by perivalvular complications, severe valvular dysfunction, or endocarditis team-guided urgent surgical indication. Coronary flow reserve correlated inversely with vegetation size (r = −0.39; p = 0.002) and regurgitation severity (r = −0.36; p = 0.004). Notably, the inverse association between coronary flow reserve and vegetation size showed substantial interindividual variability, particularly among patients with similar vegetation dimensions, suggesting heterogeneity in microvascular vulnerability beyond structural lesion burden. Despite relatively preserved mean arterial pressure across age groups, advanced imaging revealed progressive increases in systemic vascular resistance, declining wall shear stress, impaired microvascular flow, and reduced myocardial reserve. Imaging-derived cardiovascular vulnerability profiles frequently diverged from chronological age, highlighting heterogeneity in cardiovascular reserve despite apparently stable conventional hemodynamic parameters. Advanced echocardiographic and coronary Doppler imaging characterize a spectrum of biological cardiovascular vulnerability that is associated with clinically adjudicated severity in infective endocarditis, rather than serving as independent prognostic predictors. Full article

Background: Treatment decisions for older adults with locally advanced or metastatic pancreatic ductal adenocarcinoma (PDAC) often rely on heterogeneous observational evidence and clinical judgment regarding survival benefits, regimen intensity, and tolerability. Methods: We systematically searched Embase, PubMed, and Scopus from inception to 30 March 2025, for studies reporting overall survival (OS) and/or progression-free survival (PFS) in older adults with advanced PDAC receiving systemic chemotherapy, as well as age-stratified outcomes among chemotherapy-treated patients. Hazard ratios (HRs) with 95% confidence intervals (CIs) were primarily extracted from multivariable-adjusted analyses. In cases without reported HRs, estimates were derived from summary statistics or Kaplan–Meier curves. The review protocol was registered in PROSPERO (CRD420261292913). Results: A total of 40 predominantly retrospective studies were included. Chemotherapy was associated with improved OS compared to best supportive care in older adults (9 studies; HR 0.46, 95% CI 0.39–0.54; I² = 18%). Among chemotherapy-treated patients, OS (34 studies; HR 1.00, 95% CI 0.99–1.02; I² = 23%) and PFS (11 studies; HR 0.96, 95% CI 0.86–1.07; I² = 10%) did not differ by age. Combination chemotherapy demonstrated superior OS (13 studies; HR 0.66, 95% CI 0.54–0.80; I² = 86%) with substantial heterogeneity and PFS (7 studies; HR 0.63, 95% CI 0.53–0.74; I² = 30%) compared to monotherapy. FOLFIRINOX and gemcitabine plus nab-paclitaxel demonstrated comparable OS (8 studies; HR 0.98, 95% CI 0.90–1.05; I² = 60%) and PFS (2 studies; HR 0.97, 95% CI 0.92–1.02; I² = 0%). Conclusions: Among carefully selected older adults with advanced PDAC, chemotherapy was associated with improved survival compared to supportive care. Chronological age did not predict outcomes, highlighting the need for geriatric-informed prospective trials. Full article

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have proven their favorable cardiovascular and nephroprotective benefits in large randomized-controlled trials (RCTs). Given that older adults constitute a substantial part of patients with type 2 diabetes mellitus (T2DM), heart failure (HF), and chronic kidney disease (CKD), they are the primary target population for SGLT2 inhibitor therapy. However, their representation in clinical trials remains low and it does not reflect the real-life heterogeneity of this group of patients. As chronological age alone does not adequately reflect the biological age, it is important to evaluate older adults using a multidimensional approach, particularly with regard to frailty. This review aims to summarize and critically appraise the available evidence regarding the efficacy of SGLT2 inhibitors in older and frail adults, with a focus on age-specific outcomes, such as cognitive outcomes, risk of sarcopenia, functional activity and current gaps in evidence related to frailty. Full article

Saccharomyces cerevisiae is a useful model to understand the biochemistry and biology of aging. Yeast speeds up the aging study due to its short lifespan, well-established genetics, and simple measurement for lifespan. The chronological lifespan in yeast specifically emphasizes the survival rate of the population, providing data that offer more direct feedback on experimental treatments than replicative lifespan. The advancement of the yeast chronological lifespan assay has enabled researchers to efficiently screen numerous potential antiaging compounds and delve into aging theories. Through the integration of robust genetic screening and high-throughput technologies, the yeast model has facilitated the identification of various antiaging factors with potential applications in humans, shedding light on the genetic mechanisms of aging. Many natural products, similar to calorie restriction, have been shown to effectively extend the lifespan of yeast, a benefit that is also conserved in mammals. In this review, we highlight the nutrient factors, natural compounds, and genes that contribute to extending the yeast lifespan, as well as the genetic regulations underlying the aging process in yeast. Full article

Objectives: This study evaluated the accuracy of an artificial intelligence (AI)-based cephalometric software (WebCeph version 2.0.0.) compared with manual tracing and determined whether stratifying patients by chronological age or dentition stage provides a more clinically relevant assessment of AI accuracy. Methods: Three hundred lateral cephalometric radiographs of Vietnamese patients were traced manually by an orthodontist (reference standard) and analyzed automatically by WebCeph. Intra-observer reliability was validated using ICC and Dahlberg’s error. We analyzed the data using three stratification strategies: (1) Overall; (2) Chronological age (<18, 18–25, >25 years); and (3) Dentition stage (<9 primary-early mixed, 9–12 late mixed, >12 permanent). The primary outcome was the absolute measurement difference (∣Δ∣), analyzed using the Kruskal–Wallis test and effect size (${\eta }^2$). Results: Overall, WebCeph showed high concordance with manual tracing (ICC > 0.80 for most parameters). Chronological age stratification showed weak associations with measurement error; differences between groups were largely non-significant ($p>0.05$) with a small effect size (${\eta }^2\approx 0.015$). In contrast, the dentition stage revealed significant performance disparities ($p<0.05$). Notably, accuracy for the Mandibular Arc (ICC = 0.349) and Mandibular Plane Angle ($p=0.048$) degraded significantly in the primary-early mixed group, a vulnerability obscured by chronological age-based stratification. Conclusions: Dentition stage is a more sensitive and biologically relevant predictor of AI accuracy than chronological age. While WebCeph is reliable for permanent dentition, accuracy degrades significantly in the primary-early mixed phase. Clinicians should prioritize manual verification of mandibular and incisor landmarks in mixed-dentition children. Full article

DNA methylation (DNAm) age estimation is one of the hottest topics in forensic contexts. However, there is growing evidence that DNAm can be affected by several factors, including many clinical conditions. In this study, we analyzed the methylation levels within the FHL2 gene in Portuguese women using the droplet digital PCR (ddPCR) methodology to develop age prediction models (APMs). We hypothesized that obesity could affect the accuracy of APMs and would be associated with the advancement in epigenetic aging. We collected blood samples from 62 women (aged 21–58 years old) with overweight and obesity. DNA extracts were subjected to bisulfite conversion followed by ddPCR using dual-labeled probes targeting the methylated and unmethylated FHL2 CpG site cg06639320. The developed APM yielded a mean absolute deviation (MAD) of 4.72 years between predicted and chronological ages in the total sample. When applying the developed APM to women classified as overweight, the MAD was 3.64 years, while, for those with obesity class 1, it was 3.93 years, and, for those with obesity class 2, 6.29 years. The same pattern of accuracy was observed when we developed APMs specifically for the groups categorized by overweight and obesity, obtaining MAD values of 3.75 years (overweight), 3.69 years (obesity class 1) and 6.24 years (obesity class 2). Our study indicates that severe obesity may impact the accuracy of DNA methylation-based age estimators. We did not find evidence of an association between BMI and accelerated epigenetic aging. However, we found signals of epigenetic age acceleration in younger subjects and epigenetic age deceleration in the older participants. Full article