NEIGHBORHOOD ADVERSITY AND COGNITIVE HEALTH: THE MODIFYING ROLE OF SELF-PERCEPTIONS OF AGING

Research has documented the increased risk of cognitive impairment among older adults living in socioeconomically disadvantaged neighborhoods. Much less is known about the factors that moderate this risk. We conceptualized self-perception of aging (SPA) as a potential moderator because it reflects core beliefs about the self at older ages but is also closely linked to late-life health. Guided by the diathesis-stress model that postulates the interactive roles of cognitive styles and stressors in shaping health outcomes, we hypothesized that more positive SPA would buffer the effects of neighborhood adversity on cognitive function. Using data from the Health and Retirement Study (2008–2016), the analytic sample consisted of adults aged 54 and older (N=5,902). Cognitive function was assessed by the Telephone Interview for Cognitive Status. The neighborhood indicators included 1) poverty rates at the census tract level, 2) perceived neighborhood social cohesion, and 3) perceived neighborhood disorder. Three-level growth curve models were separately estimated for each neighborhood indicator’s effect as well as its interaction with SPA on the 8-year cognitive function trajectories. Findings showed that higher poverty rates, more disorder, and less cohesion were associated with lower initial levels of cognitive function but slower rates of cognitive decline. SPA partially moderated the linkage between neighborhood adversity and the level of cognitive function. More positive SPA was associated with reduced negative effects of living in neighborhoods with higher poverty rates and more physical disorder. These findings highlight the intersection of an individual-level psychological factor and a contextual-level factor in shaping late-life cognition.

SOCIAL DETERMINANTS OF HEALTH AND WILLINGNESS FOR END-OF-LIFE DISCUSSION AMONG KOREAN AMERICAN IMMIGRANTS

This study aimed to examine social determinants of health (SDH) associated with Korean American (KA) immigrants’ willingness for end-of-life discussions with family and doctors. A self-administered, cross-sectional survey was conducted with 259 KAs in Alabama. Demographic, health, acculturation, and SDH information were collected. Binary logistic regression analyses were conducted to examine associations between SDH and willingness for end-of-life discussion. Most participants were willing to discuss with family (94%) and doctors (82%). Those aware of hospice care were more likely to have willingness for discussion with family and doctors. Those who could not see a doctor because of cost and who had higher threats to interpersonal safety were less likely to have willingness for discussion with family. Those with more chronic conditions and higher social isolation were less likely to have willingness for discussion with doctors. Interventions aimed to promote KAs' end-of-life discussions should consider the SDH identified in this study.

Comparing bilateral feet computed tomography scans can improve surgical decision making for subtle Lisfranc injury

INTRODUCTION

Subtle Lisfranc injuries (SLIs) are challenging to diagnose. Although weightbearing (WB) radiographs have been suggested to identify SLIs, approximately 20% are missed on initial radiographic assessment. Computed tomography (CT) has been suggested as an alternative, but has not provided any diagnostic guideline. Therefore we compared measurement techniques on radiographs and bilateral foot CT scans for the efficiency of diagnosis and making surgical decisions for SLI.

METHODS

We retrospectively investigated patients diagnosed with SLIs between January 2014 and January 2020. Distances between both medial cuneiform and second metatarsal base (C1M2), and the first and second metatarsal bases (M1M2), were measured on bilateral WB radiographs. Bilateral foot CT scans were taken, and the distances between C1M2 were checked on the axial and three points of the coronal plane (top, middle, and base). The surgical indication was > 1 mm of diastasis on CT scan. Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score at final follow-up. Intraobserver and interobserver agreements were assessed.

RESULTS

Thirty patients with SLIs were reviewed. Twenty-four patients underwent surgical fixation (Group A) and six patients were treated conservatively (Group B). The side-to-side difference (STSD) of C1M2 and M1M2 distances greater than 1 mm showed 91.7% and 54.2% sensitivity, and 66.7% and 16.7% specificity, respectively. Investigating STSDs of all points on CT scans were informative to discriminate both groups (P ≤ 0.038). Clinical outcomes showed no significant difference between the groups (P = 0.631). Intraclass and interclass correlation coefficient values showed good to very good reliability, except for STSD of WB M1M2 distance and the coronal top plane.

CONCLUSION

Investigating bilateral foot CT scans was significantly efficient and reliable for the diagnosis and treatment plan for SLI. On radiographs, STSD of WB C1M2 distance was more sensitive than STSD of WB M1M2 distance.

LEVEL OF EVIDENCE

Case control study; III.

Mouse models of Kras activation in gastric cancer

Gastric cancer has one of the highest incidence rates and is one of the leading causes of cancer-related mortality worldwide. Sequential steps within the carcinogenic process are observed in gastric cancer as well as in pancreatic cancer and colorectal cancer. Kirsten rat sarcoma viral oncogene homolog (KRAS) is the most well-known oncogene and can be constitutively activated by somatic mutations in the gene locus. For over 2 decades, the functions of Kras activation in gastrointestinal (GI) cancers have been studied to elucidate its oncogenic roles during the carcinogenic process. Different approaches have been utilized to generate distinct in vivo models of GI cancer, and a number of mouse models have been established using Kras-inducible systems. In this review, we summarize the genetically engineered mouse models in which Kras is activated with cell-type and/or tissue-type specificity that are utilized for studying carcinogenic processes in gastric cancer as well as pancreatic cancer and colorectal cancer. We also provide a brief description of histological phenotypes and characteristics of those mouse models and the current limitations in the gastric cancer field to be investigated further.

Social determinants of willingness to discuss end-of-life care with family and doctors among Korean American immigrants: Findings from a cross-sectional survey in Alabama

Prior research reported lower engagement in end-of-life discussions and planning among Korean American (KA) immigrants; however, there is a dearth of research investigating factors associated with their willingness to discuss their end-of-life care wishes. This study aimed to examine the willingness to have end-of-life discussions with family and doctors among KA immigrants and social determinants of health (SDH) associated with willingness. A self-administered, cross-sectional survey was conducted with a convenience sample of 259 KA immigrants recruited from two counties in Alabama. Demographic, health, acculturation and SDH information were collected. Logistic regression analyses were conducted to examine associations between SDH and willingness for end-of-life discussion with family and doctors, respectively. The majority of the sample was willing to discuss end-of-life care with family (94%) and doctors (82%). Those with hospice awareness were more likely to have willingness for discussion with family (OR = 27.70, p < 0.001) and doctors (OR = 5.01, p < 0.001). Those who could not see a doctor because of cost (OR = 0.03, p < 0.01) and who had higher threats to interpersonal safety (OR = 0.74, p < 0.05) were less likely to have willingness for discussion with family. Those who had more chronic conditions (OR = 0.60, p < 0.05) and higher levels of social isolation (OR = 0.77, p < 0.05) were less likely to have willingness for discussion with doctors. The SDH identified in this study should be considered in developing interventions to promote end-of-life discussions in the KA immigrant community. Future research should investigate the associations explored in this study in a larger and more representative sample.

Impact of mental disease on the risk of atrial fibrillation in patients with diabetes mellitus: a nationwide population-based study

Background

Diabetes mellitus (DM) is known to increase the risk of mental disorders, which increases the health care burden in these patients. Also, DM is one of the risk factors leading to atrial fibrillation (AF), and the presence of concomitant AF and DM adds to the increased risks of stroke and death. It is uncertain whether mental disease is an independent risk factor of incident AF in patients with DM.

Purpose

To investigate whether diabetic patients with mental disease have an increased risk of AF.

Methods

Using the Korea National Health Insurance Service database, we enrolled 2,512,690 patients diagnosed with DM without AF between 2009 and 2021. Newly diagnosed AF was identified during the follow-up period. We compared the risk of AF between patients with mental disease and those without.

Results

Among the total population, 828,929 (32.99%; mean age 61.58±11.28; 56.71% female) patients were diagnosed with mental diseases (Figure 1). Anxiety (564,786 patients, 68.13%) was the most common mental disease, while depression was the second most common (313,773 patients, 37.85%). Diabetic patients with mental diseases had a higher percentage of women, hypertension, dyslipidemia, chronic kidney failure, congestive heart failure, obstructive sleep apnea, and thyroid disease. During a median 7.0 years (IQR 5.93–8.07) follow-up, 34,523 were diagnosed new-onset AF (4.66 per 1,000 person-year). In multivariate analysis, diabetic patients with mental disorders showed a higher risk of new-onset AF (HR 1.19; 95% CI 1.17–1.21; p-value &lt;0.0001) (Figure 2). Among mental diseases, depression, insomnia, and anxiety were associated with increased risks of new-onset AF (HR 1.15; 95% CI 1.12–1.17; HR 1.15; 95% CI 1.13–1.18; and HR 1.19; 95% CI, 1.67–1.21; all p-value &lt;0.0001, respectively), whereas bipolar disorder and schizophrenia showed non-statistically significant trends (due to small numbers). Subgroup analyses showed that younger age had significant interactions with depression, insomnia, and anxiety.

Conclusion

Mental diseases, especially depression, insomnia, and anxiety, showed an increased risk of AF in patients with DM. Awareness and prompt diagnosis and management of AF would be necessary for these high-risk populations at risk of incident AF.

Funding Acknowledgement

Type of funding sources: None.

External validation of the biomarker based ABCD score in atrial fibrillation patients with a non gender CHA2DS2 VASc score 0 to 1, A Korean multicenter retrospective cohort

Background

Patients with low to intermediate risk atrial fibrillation (AF), defined as non-gender CHA2DS2-VASc score of 0–1, are still at risk of stroke. This study verified the usefulness of ABCD score (Age [≥60 years], B-type natriuretic peptide [BNP] or N-terminal pro-BNP [≥300 pg/ml], Creatinine clearance [&lt;50 ml/min/1.73 m2], and Dimension of the left atrium [≥45 mm]) for stroke risk stratification in non-gender CHA2DS2-VASc score 0–1.

Methods

This multi-center cohort study retrospectively analyzed AF patients with non-gender CHA2DS2-VASc score 0–1. The primary endpoint was the incidence of stroke with or without anti-thrombotic treatment (ATT). An ABCD score was also validated.

Results

Overall, 2694 patients (56.3±9.5 years; female, 726 [26.9%]) were followed-up for 4.0±2.8 years. The overall stroke rate was 0.84/100 person-years (P-Y), stratified as follows: 0.46/100P-Y for an ABCD score 0; 1.02/100P-Y for an ABCD score≥1. The ABCD score was superior to the non-gender CHA2DS2-VASc score in stroke risk stratification (C-index=0.618, P=0.015; net reclassification improvement=0.576, P=0.040; integrated differential improvement=0.033, P=0.066). ATT was prescribed in 2353 patients (86.5%), and the stroke rate was significantly lower in patients receiving non-vitamin K antagonist oral anticoagulant (NOAC) therapy and an ABCD score≥1 than in those without ATT (0.44/100P-Y versus 1.55/100 P-Y; hazard ratio=0.26, 95% confidence interval 0.11–0.63, P=0.003).

Conclusion

The biomarker-based ABCD score demonstrated improved stroke risk stratification in AF patients with non-gender CHA2DS2-VASc score 0–1. Furthermore, NOAC with an ABCD score≥1 was associated with significantly lower stroke rate in AF patients with a non-gender CHA2DS2-VASc score 0–1.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Korean Disease Control and Prevention Agency

Dysplastic Stem Cell Plasticity Functions as a Driving Force for Neoplastic Transformation of Precancerous Gastric Mucosa

BACKGROUND & AIMS

Dysplasia carries a high risk of cancer development; however, the cellular mechanisms for dysplasia evolution to cancer are obscure. We have previously identified 2 putative dysplastic stem cell (DSC) populations, CD44v6neg/CD133+/CD166+ (double positive [DP]) and CD44v6+/CD133+/CD166+ (triple positive [TP]), which may contribute to cellular heterogeneity of gastric dysplasia. Here, we investigated functional roles and cell plasticity of noncancerous Trop2+/CD133+/CD166+ DSCs initially developed in the transition from precancerous metaplasia to dysplasia in the stomach.

METHODS

Dysplastic organoids established from active Kras-induced mouse stomachs were used for transcriptome analysis, in vitro differentiation, and in vivo tumorigenicity assessments of DSCs. Cell heterogeneity and genetic alterations during clonal evolution of DSCs were examined by next-generation sequencing. Tissue microarrays were used to identify DSCs in human dysplasia. We additionally evaluated the effect of casein kinase 1 alpha (CK1α) regulation on the DSC activities using both mouse and human dysplastic organoids.

RESULTS

We identified a high similarity of molecular profiles between DP- and TP-DSCs, but more dynamic activities of DP-DSCs in differentiation and survival for maintaining dysplastic cell lineages through Wnt ligand-independent CK1α/β-catenin signaling. Xenograft studies demonstrated that the DP-DSCs clonally evolve toward multiple types of gastric adenocarcinomas and promote cancer cell heterogeneity by acquiring additional genetic mutations and recruiting the tumor microenvironment. Last, growth and survival of both mouse and human dysplastic organoids were controlled by targeting CK1α.

CONCLUSIONS

These findings indicate that the DSCs are de novo gastric cancer-initiating cells responsible for neoplastic transformation and a promising target for intervention in early induction of gastric cancer.

Expanded targeting scope of LbCas12a variants allows editing of multiple oncogenic mutations

RNA-guided CRISPR-Cas12a endonucleases are promising tools for genome engineering. Here we demonstrate that LbCas12a variants derived from Lachnospiraceae bacterium show a broad PAM preference, recognizing certain non-canonical PAMs with high efficiency. Furthermore, we engineered LbABE8e to carry G532R and/or K595R mutations, altering its original PAM specificities; these variants exhibited superior base editing activity in human cells compared with wild-type LbABE8e at sites with non-canonical PAMs. Based on this finding, we utilized the most effective LbCas12a and LbABE8e variants to demonstrate multiplexed and mutant-allele-specific gene editing in oncogenes, made possible by the variant’s recognition of non-canonical PAMs. Importantly, LbCas12a-G532R/K595R and LbABE8e-G532R/K595R with optimized crRNA arrays targeted to triple oncogenic mutations inhibited colon cancer cell proliferation. Taken together, these results demonstrate the potential of engineered LbCas12a and LbABE8e as tools for targeting sites with alternative PAMs for genome engineering and therapeutic editing in cancer cells.

Chief cell plasticity is the origin of metaplasia following acute injury in the stomach mucosa

OBJECTIVE

Metaplasia arises from differentiated cell types in response to injury and is considered a precursor in many cancers. Heterogeneous cell lineages are present in the reparative metaplastic mucosa with response to injury, including foveolar cells, proliferating cells and spasmolytic polypeptide-expressing metaplasia (SPEM) cells, a key metaplastic cell population. Zymogen-secreting chief cells are long-lived cells in the stomach mucosa and have been considered the origin of SPEM cells; however, a conflicting paradigm has proposed isthmal progenitor cells as an origin for SPEM.

DESIGN

Gastric intrinsic factor (GIF) is a stomach tissue-specific gene and exhibits protein expression unique to mature mouse chief cells. We generated a novel chief cell-specific driver mouse allele, GIF-rtTA. GIF-GFP reporter mice were used to validate specificity of GIF-rtTA driver in chief cells. GIF-Cre-RnTnG mice were used to perform lineage tracing during homoeostasis and acute metaplasia development. L635 treatment was used to induce acute mucosal injury and coimmunofluorescence staining was performed for various gastric lineage markers.

RESULTS

We demonstrated that mature chief cells, rather than isthmal progenitor cells, serve as the predominant origin of SPEM cells during the metaplastic process after acute mucosal injury. Furthermore, we observed long-term label-retaining chief cells at 1 year after the GFP labelling in chief cells. However, only a very small subset of the long-term label-retaining chief cells displayed the reprogramming ability in homoeostasis. In contrast, we identified chief cell-originating SPEM cells as contributing to lineages within foveolar cell hyperplasia in response to the acute mucosal injury.

CONCLUSION

Our study provides pivotal evidence for cell plasticity and lineage contributions from differentiated gastric chief cells during acute metaplasia development.

Opioid Literacy Among African Americans Living in Rural Alabama: Findings From a Social Determinants of Health (SDH) Framework

Limited research examining opioid literacy among African Americans (AAs) have been conducted. The current study examined the association between opioid literacy levels among AAs in rural Alabama using the social determinants of health framework. Three subscales in the Brief Opioid Overdose Knowledge questionnaire were used to measure opioid literacy. Among a sample of 253, limited opioid literacy was found. Social contact was found to be significantly associated with overall opioid literacy (B = .36, p < .05) and opioid general knowledge subscale (B = .14, p < .05). For the subscale of opioid overdose response knowledge, health insurance (B =−.59, p = .06) and social contact (B = .13, p = .07) emerged as marginally significant. The findings suggest that educational interventions are needed to increase opioid literacy among rural AAs, especially among those with limited social contact.

Revealing the Dynamics of the Thermal Reaction between Copper and Mixed Halide Perovskite Solar Cells

Copper (Cu) is present not only in the electrode for inverted-structure halide perovskite solar cells (PSCs) but also in transport layers such as copper iodide (CuI), copper thiocyanate (CuSCN), and copper phthalocyanine (CuPc) alternatives to spiro-OMeTAD due to their improved thermal stability. While Cu or Cu-incorporated materials have been effectively utilized in halide perovskites, there is a lack of thorough investigation on the direct reaction between Cu and a perovskite under thermal stress. In this study, we investigated the thermal reaction between Cu and a perovskite as well as the degradation mechanism by X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), and Kelvin probe force microscopy (KPFM). The results show that high temperatures of 100 °C induce Cu to be incorporated into the perovskite lattice by forming "Cu-rich yet organic A-site-poor" perovskites, (Cu_xA_1-x)PbX₃, near the grain boundaries, which result in device performance degradation.

p57Kip2 imposes the reserve stem cell state of gastric chief cells

Adult stem cells constantly react to local changes to ensure tissue homeostasis. In the main body of the stomach, chief cells produce digestive enzymes; however, upon injury, they undergo rapid proliferation for prompt tissue regeneration. Here, we identified p57Kip2 (p57) as a molecular switch for the reserve stem cell state of chief cells in mice. During homeostasis, p57 is constantly expressed in chief cells but rapidly diminishes after injury, followed by robust proliferation. Both single-cell RNA sequencing and dox-induced lineage tracing confirmed the sequential loss of p57 and activation of proliferation within the chief cell lineage. In corpus organoids, p57 overexpression induced a long-term reserve stem cell state, accompanied by altered niche requirements and a mature chief cell/secretory phenotype. Following the constitutive expression of p57 in vivo, chief cells showed an impaired injury response. Thus, p57 is a gatekeeper that imposes the reserve stem cell state of chief cells in homeostasis.

Controllable Acceleration and Deceleration of Charge Carrier Transport in Metal-Halide Perovskite Single-Crystal by Cs-Cation Induced Bandgap Engineering

Charge carrier transport in materials is of essential importance for photovoltaic and photonic applications. Here, the authors demonstrate a controllable acceleration or deceleration of charge carrier transport in specially structured metal-alloy perovskite (MACs)PbI₃ (MA= CH₃ NH₃ ) single-crystals with a gradient composition of CsPbI₃ /(MA_{1- x} Cs_x )PbI₃ /MAPbI₃ . Depending on the Cs-cation distribution in the structure and therefore the energy band alignment, two different effects are demonstrated: i) significant acceleration of electron transport across the depth driven by the gradient band alignment and suppression of electron-hole recombination, benefiting for photovoltaic and detector applications; and ii) decelerated electron transport and thus improved radiative carrier recombination and emission efficiency, highly beneficial for light and display applications. At the same time, the top Cs-layer results in hole localization in the top layer and surface passivation. This controllable acceleration and deceleration of electron transport is critical for various applications in which efficient electron-hole separation and suppressed nonradiative electron-hole recombination is demanded.