High Protein Intake Is Associated with Lower Risk of All-Cause Mortality in Community-Dwelling Chinese Older Men and Women

OBJECTIVES

To examine the association of the quantity and the source of protein intake with mortality risk in Chinese older adults.

DESIGN

Prospective cohort study.

SETTING

Community.

PARTICIPANTS

Community-dwelling Chinese adults aged >=65 (1,480 men, 1,540 women) in Hong Kong.

MEASUREMENTS

Food frequency questionnaire was used to capture baseline dietary intakes including protein, fiber, total grains, vegetables and fruit intakes. Primary outcome measures, identified from the death registry, were death from all causes, cancer and cardiovascular disease (CVD). Other demographic and lifestyle risk factors were also collected. Multivariate Cox proportion hazards regression was used to examine the association of protein intake with mortality risk.

RESULTS

During a median of 13.8 follow-up years, 963 all-cause deaths, 336 cancer deaths, and 205 CVD deaths were identified. Among men in the highest quintile of total protein intake, all-cause mortality and cancer mortality decreased by 29% [95% confidence interval (CI): 0.55-0.92, p-trend=0.017] and 38% [95% CI: 0.39-0.97, p-trend=0.041] respectively compared with men in the lowest quintile after adjustment for demographics, lifestyle factors and medical conditions. Men in the highest quintile of animal protein intake showed 20% reduced risk of all-cause mortality than men in the lowest quintile (p-trend=0.042). Women in the highest quintile of plant protein intake showed 39% decreased risk of all-cause mortality [95% CI: 0.44-0.85, p-trend=0.019] than those in the lowest quintile. In women, protein intake was not associated with cancer mortality. In both men and women, protein intake was not associated with CVD morality. Further adjustment for other dietary variables attenuated the significant associations.

CONCLUSIONS

Contrary to findings from Caucasian populations of all ages, among Chinese older adults, higher total protein intake was associated with lower all-cause and cancer mortality in Chinese older men. While higher animal protein intake was associated with reduced all-cause mortality in Chinese older men, higher plant protein intake was protective against all-cause mortality in Chinese women. The attenuated associations between protein intake and mortality risk after adjustment for other dietary variables also highlight the role of whole diet approach in mortality risk reduction among older adults.

Computed Tomographic Perfusion Predicts Poor Outcomes in a Randomized Trial of Endovascular Therapy

Background and Purpose—

In the ESCAPE trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times), patients with large vessel occlusions and small infarct cores identified with computed tomography (CT)/CT angiography were randomized to endovascular therapy or standard of care. CT perfusion (CTP) was obtained in some cases but was not used to select patients. We tested the hypothesis that patients with penumbral CTP patterns have higher rates of good clinical outcome.

Methods—

All CTP data acquired in ESCAPE patients were analyzed centrally using a semiautomated perfusion threshold-based approach. A penumbral pattern was defined as an infarct core <70 mL, penumbral volume >15 mL, and a total hypoperfused volume:core volume ratio of >1.8. The primary outcome was good functional outcome at 90 days (modified Rankin Scale score, 0–2).

Results—

CTP was acquired in 138 of 316 ESCAPE patients. Penumbral patterns were present in 116 of 128 (90.6%) of patients with interpretable CTP data. The rate of good functional outcome in penumbral pattern patients (53 of 114; 46%) was higher than that in nonpenumbral patients (2 of 12; 17%; P =0.041). In penumbral patients, endovascular therapy increased the likelihood of a good clinical outcome (34 of 58; 57%) compared with those in the control group (19 of 58; 33%; odds ratio, 2.68; 95% confidence interval, 1.25–5.76; P =0.011). Only 3 of 12 nonpenumbral patients were randomized to the endovascular group, preventing an analysis of treatment effect.

Conclusions—

The majority of patients with CTP imaging in the ESCAPE trial had penumbral patterns, which were associated with better outcomes overall. Patients with penumbra treated with endovascular therapy had the greatest odds of good functional outcome. Nonpenumbral patients were much less likely to achieve good outcomes.

Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study

Background

Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.

Methods and Results

A random subcohort of 349 participants was selected from the DCCT / EDIC (Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from DCCT baseline, year 1, and closeout of DCCT , and 1 to 2 years post‐ DCCT ( EDIC years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F 2α isoprostanes, and its metabolite, 2,3 dinor‐8 iso prostaglandin F 2α . Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8 iso prostaglandin F 2α , an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase, P <0.003; −5.3% risk for 10% higher 2,3 dinor‐8 iso prostaglandin F 2α , P =0.0092). In contrast, the oxidative markers myeloperoxidase and F 2α isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between DCCT intensive and conventional treatment groups in the change in all biomarkers across time segments.

Conclusions

Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.

Clinical Trial Registration

URL : https://www.clinicaltrials.gov . Unique identifiers: NCT 00360815 and NCT 00360893.

Studying Older People with Visual Impairments Using Mainstream Smartphones with the Aid of the EziSmart Keypad and Apps

This paper reports on a study of older people with visual impairments learning to use a mainstream smartphone with touchscreen. The aim of the study was to evaluate whether the EziSmart solution could facilitate the use of a standard off-the-shelf smartphone, and thus stimulate more social contact and digital participation for this group. The EziSmart solution consists of Ezi-Pad and Ezi-Smart Apps. The Ezi-Pad is a flip-casing with a receptacle for the smartphone. When the casing is flipped open it reveals an integrated keyboard with large ergonomic physical keys. The smartphone and the Ezi-Pad keyboard communicate via Bluetooth. The Ezi-Smart Apps is a set of Android applications including a startpage (launcher), an app organizer and several other features. Six visually impaired adults, aged 63 to 80 years received a five day course in using a smartphone together with the EziSmart solution. The participants were observed during the course. They were then followed up during a two month period. The participants and their relatives were interviewed about their smartphone use, experiences and expectations before the training started, and after the follow up period ended. We discuss challenges that older people with visual impairment face when trying to learn and use a smartphone. We then report on the usability and accessibility of the Ezi-Pad solution, describe the course and the experiences of the participants, and reflects upon how both the EziSmart solution and smartphone training could be improved with regard to this user group.

A Study of Patients who Leave an Accident & Emergency Department against Medical Advice

Patients leaving an Accident & Emergency Department against medical advice are often considered a high-risk group. A prospective study was carried out in an Accident & Emergency Department (ED) to determine the characteristics of this distinct group of patients, their reasons for leaving against medical advice (AMA), and their subsequent outcome. Telephone or personal interview of patients by a clerk was attempted within 48 hours of the visit for all patients who left Against Medical Advice (AMA) based on a pre-set questionnaire. A follow-up call was used to ascertain health outcomes after the discharge. There were 210 AMA cases during the study period giving an incidence of 0.95%. Interview was successful in 186 (88.6%) patients. The mean age of the AMA group was around 36 years but there was no significant difference in sex. The major reasons for AMA included wanting to observe symptoms at home (78 of 186, 42 %), non-medical personal reason (64 of 186, 34%) and symptoms have abated (21 of 186, 11%). Eighteen (9.7%) patients left AMA because they wanted to seek treatment from other providers and among them three had private insurance coverage. Of the 5 (2.7%) patients who were dissatisfied with the management in ED, four disagreed with the diagnosis and treatment offered and the remaining one was unhappy with the attitude of the attending physician. About 12% (22) of patients returned within 48 hours for further treatment and 8 (36%) were admitted. The remaining 22% (40 of 186) sought further medical treatment from other sources. No formal patient complaint was received during the study period from this group.

Anti-vimentin Antibodies Present at the Time of Transplantation May Predict Early Development of Interstitial Fibrosis/Tubular Atrophy

BACKGROUND

Anti-vimentin (a cytoskeletal protein) autoantibodies in renal transplant recipients have been correlated with interstitial fibrosis/tubular atrophy (IFTA). In this study, we examine the association between pretransplantation anti-vimentin antibodies and the subsequent development of IFTA.

METHODS

Sera obtained before renal transplantation from 97 transplant recipients were analyzed for the presence of anti-vimentin antibodies via Luminex assays to determine the concentration of anti-vimentin antibodies. Results were correlated with findings of IFTA on biopsy as well as graft function and patient and graft survival.

RESULTS

In our patient population, 56 of 97 patients were diagnosed by biopsy with IFTA 2.9 (±2.1) years after renal transplantation. Patients with IFTA on biopsy had higher mean concentration of anti-vimentin antibodies when compared to patients without IFTA (32.2 μg/mL [3.97-269.12 μg/mL] vs 14.57 μg/mL [4.71-87.81 μg/mL]). The risk of developing IFTA with a concentration of anti-vimentin antibody >15 μg/mL before transplantation was 1.96 (95% CI = 1.38-2.79, P = .011). Patients with elevated anti-vimentin antibody concentrations (>15 μg/mL) at the time of transplantation also had a higher risk of developing IFTA (81.4% vs 41.2%; P < .05). In addition, graft function was worse at 1, 3, and 5 years posttransplantation in patients with elevated concentrations of pretransplantation anti-vimentin antibody. Although there were more graft losses in the IFTA groups (49.12% vs 25.64%, P = .021) and the IFTA patients loss their grafts earlier (4.3 years vs 3.6 years), there was no statistical difference in graft loss rates.

CONCLUSIONS

Pretransplantation anti-vimentin antibody concentrations >15 μg/mL may be a risk factor for IFTA.

A User Study: Keyboard and Applications to Simplify Smartphone Adoption for Seniors

The aim of the user study was to evaluate how the developed assistive physical keyboard, the Ezi-PAD, and integrated senior friendly applications, can encourage non-smartphone seniors to start using the smartphone and enable senior smartphone users to continue using a smartphone in spite of increasing motoric or visual impairment. A number of seniors with different experience and impairment, aged 64 to 86, were equipped with a smartphone and an Ezi-PAD assembly. After basic training, their use of the smartphone was monitored for up to 2 months. Five out of nine participants used the system for 2 months, and found the Ezi-PAD easy to use. The senior friendly applications gave extra utilitarian value to the phone.

A new top-loading venous bag provides vacuum-assisted venous drainage

A new venous bag has been developed, prototyped, and tested. The new bag has its inlet, outlet purge, and infusion tubes extending upward from the top of the bag, and are threaded through, bonded to, and sealed within a flat rigid top plate. This design allows the bag to be hung from its top plate by its tubes. It also allows the bag to be: 1) dropped into or removed from its holder, as is done with existing hard-shell reservoirs so that its weight pulls it into the holder without the need for eyelets and hooks and 2) placed closer to the floor so that gravity drainage is facilitated. The V-Bag® (VB) is easily sealed within an accompanying rigid housing. Once sealed, vacuum applied to the housing is transmitted across the flexible walls of the bag to the venous blood. Thus, vacuum-assisted venous drainage (VAVD) is obtained as it is with a hard-shell reservoir, but without any contact of air with the blood. Bench tests, using a circuit that simulated the venous side of the cardiopulmonary bypass (CPB) circuit, showed that applying suction to the housing increased venous flow, and the fractional increase in flow was not a function of the venous cannula, but of the level of vacuum applied. In the gravity drainage mode, the bubble counts at the outlet of the V-Bag compared to two other bags were lower at any pumping condition. When used in the VAVD mode, bubble counts were two orders of magnitude lower than when using kinetically assisted venous drainage (KAVD) with a centrifugal pump. Results obtained with the VB suggest its clinical usefulness.