Intestinal Translocation of Live Porphyromonas gingivalis Drives Insulin Resistance

Periodontitis has been emphasized as a risk factor of insulin resistance-related systemic diseases. Accumulating evidence has suggested a possible "oral-gut axis" linking oral infection and extraoral diseases, but it remains unclear whether periodontal pathogens can survive the barriers of the digestive tract and how they play their pathogenic roles. The present study established a periodontitis mouse model through oral ligature plus Porphyromonas gingivalis inoculation and demonstrated that periodontitis aggravated diet-induced obesity and insulin resistance, while also causing P. gingivalis enrichment in the intestine. Metabolic labeling strategy validated that P. gingivalis could translocate to the gastrointestinal tract in a viable state. Oral administration of living P. gingivalis elicited insulin resistance, while administration of pasteurized P. gingivalis had no such effect. Combination analysis of metagenome sequencing and nontargeted metabolomics suggested that the tryptophan metabolism pathway, specifically indole and its derivatives, was involved in the pathogenesis of insulin resistance caused by oral administration of living P. gingivalis. Moreover, liquid chromatography-high-resolution mass spectrometry analysis confirmed that the aryl hydrocarbon receptor (AhR) ligands, mainly indole acetic acid, tryptamine, and indole-3-aldehyde, were reduced in diet-induced obese mice with periodontitis, leading to inactivation of AhR signaling. Supplementation with Ficz (6-formylindolo (3,2-b) carbazole), an AhR agonist, alleviated periodontitis-associated insulin resistance, in which the restoration of gut barrier function might play an important role. Collectively, these findings reveal that the oral-gut translocation of viable P. gingivalis works as a fuel linking periodontitis and insulin resistance, in which reduction of AhR ligands and inactivation of AhR signaling are involved. This study provides novel insight into the role of the oral-gut axis in the pathogenesis of periodontitis-associated comorbidities.

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

Association of intraoperative cerebral and somatic tissue oxygen saturation with postoperative acute kidney injury in adult patients undergoing multiple valve surgery

BACKGROUND

The association between tissue oxygenation with postoperative acute kidney injury (AKI) in adult patients undergoing multiple valve surgery has not been specifically studied.

METHODS

In this prospective exploratory cohort study, 99 patients were enrolled. The left forehead, the left forearm, the left upper thigh, and the left renal region tissue oxygen saturation using near-infrared spectroscopy were monitored. The association between each threshold and AKI was assessed. The relative and absolute thresholds were < 70%, < 75%, < 80%, < 85%, < 90%, < 95%, and < 100% baseline, and baseline-standard deviation (SD), -1.5 SD, -2 SD, -2.5 SD, and -3 SD. Multivariate logistic regression analysis was adopted to explore the association.

RESULTS

AKI occurred in 53 (54%) patients. The absolute value-based SrrO2 thresholds associated with AKI were baseline-3 SD (odds ratio [OR], 4.629; 95% confidence interval [CI], 1.238-17.314; P = 0.023) and baseline-2.5 SD (OR, 2.842; 95% CI, 1.025-7.881; P = 0.045) after adjusting for the potential confounders, those are renal region tissue oxygen saturation of 55% and 60%, but not statistically significant after correcting for multiple testing (corrected P = 0.114 and 0.179, respectively).

CONCLUSION

The SrrO2 desaturation, defined as < baseline - 2.5 SD or < baseline - 3 SD, may be associated with AKI. The thresholds need to be verified in future large-scale studies.

TRIAL REGISTRATIONS

The study was registered at ClinicalTrials.gov, first trial registration: 26/10/2017, identifier: NCT03323203.

[Clinical characteristics and prognosis of patients with therapy-related myelodysplastic syndrome and acute myeloid leukemia arising from malignant tumors]

Objective: To investigate the clinical characteristics, cytogenetics, molecular biology, treatment, and prognosis of patients with therapy-related myelodysplastic syndrome and acute myeloid leukemia (t-MDS/AML) secondary to malignancies. Methods: The clinical data of 86 patients with t-MDS/AML in West China Hospital of Sichuan University between January 2010 and April 2023 were retrospectively analyzed. The clinical characteristics, primary tumor types, and tumor-related therapies were analyzed. Results: The study enrolled a total of 86 patients with t-MDS/AML, including 67 patients with t-AML, including 1 patient with M(0), 6 with M(1), 27 with M(2), 9 with M(3), 12 with M(4), 10 with M(5), 1 with M(6), and 1 with M(7). Sixty-two patients could be genetically stratified, with a median overall survival (OS) of 36 (95% CI 22-52) months for 20 (29.9%) patients in the low-risk group and 6 (95% CI 3-9) months for 10 (14.9%) in the intermediate-risk group. The median OS time was 8 (95% CI 1-15) months in 32 (47.8%) patients in the high-risk group. For patients with non-acute promyelocytic leukemia (APL) and AML, the median OS of the low-risk group was 27 (95% CI 18-36) months, which was significantly longer than that of the non-low-risk group (χ(2)=5.534, P=0.019). All 9 APL cases were treated according to the initial treatment, and the median OS was not reached, and the 1-, 2-, and 3-year OS rates were 100.0%, (75.0±6.2) %, and (75.0±6.2) % respectively. Of the 58 patients with non-APL t-AML (89.7%), 52 received chemotherapy, and 16 achieved complete remission (30.8%) after the first induction chemotherapy. The 1-, 2-, and 3-year OS rates of the non-APL t-AML group were (42.0 ± 6.6) %, (22.9±5.7) %, and (13.4±4.7) %, respectively. The median OS of patients who achieved remission was 24 (95% CI 18-30) months, and the median OS of those who did not achieve remission was 6 (95% CI 3-9) months (χ(2)=10.170, P=0.001). Bone marrow CR was achieved in 7 (53.8%) of 13 patients treated with vineclar-containing chemotherapy, with a median OS of 12 (95% CI 9-15) months, which was not significantly different from that of vineclar-containing chemotherapy (χ(2)=0.600, P=0.437). In 19 patients with t-MDS, the 1-, 2-, and 3-year OS rates were (46.8±11.6) %, (17.5±9.1) %, and (11.7±9.1) % with a median OS of 12 (95% CI 7-17) months, which was not significantly different from that in t-AML (χ(2)=0.232, P=0.630) . Conclusions: Breast cancer, bowel cancer, and other primary tumors are common in patients with t-MDS/AML, which have a higher risk of adverse genetics. Patients with APL had a high induction remission rate and a good long-term prognosis, whereas patients without APL had a low remission rate and a poor long-term prognosis.

Consistency of the anesthesia consciousness index versus the bispectral index during laparoscopic gastrointestinal surgery with sevoflurane anesthesia: A prospective multi-center randomized controlled clinical study

Background

This study aimed to compare the consistency of anesthesia consciousness index (Ai) with that of bispectral index (BIS) in monitoring the depth of anesthesia (DOA) during sevoflurane anesthesia, to reveal the optimal cutoff values in different states of consciousness, and explore the stability of DOA monitoring during intraoperative injurious stimulation.

Methods

We enrolled 145 patients (97 men and 48 women) from 10 medical centers. General anesthesia was induced using intravenous anesthetics and maintained with sevoflurane. Ai and BIS values were recorded.

Results

The mean difference between the Ai and BIS was-0.1747 (95% confidence interval, −0.6660 to 0.3166; p = 0.4857). The regression equation of Ai and BIS from the Deming regression analysis was y = 5.6387 + 0.9067x (y is BIS, x is Ai), and the slope and intercept were statistically significant. Meanwhile, the receiver operating characteristic curve analysis of anesthesia-induced unconsciousness, loss of consciousness, and recovery of consciousness revealed that the accuracy of Ai and BIS were similar. In addition, the optimal cutoff values of the different states of consciousness were not sensitive to age, and both Ai and BIS had no correlation with hemodynamics.

Conclusion

We conclude that Ai and BIS show no systematic deviation in readings with high consistency, similar accuracy, and good stability; these insights provide more data for clinical application.

[Intermittent heat exposure induces thoracic aorta injury in spontaneously hypertensive rats by activating the AMPK/mTOR/ULK1 pathway]

OBJECTIVE

To investigate the effects of different manners of heat exposure on thoracic aorta injury in spontaneously hypertensive rats (SHRs) and explore the underlying mechanism.

METHODS

Normal 6 to 7-week-old male SHRs were randomized into control group (cage at room temperature), intermittent heat exposure group (SHR-8 group, exposed to 32 ℃ for 8 h daily for 7 days) and SHR-24 group (with continuous exposure to 32 ℃ for 7 days). After the treatments, the pathologies of the thoracic aorta of the rats were observed with HE staining, and the expressions of Beclin1, LC3B and p62 were detected with Western blotting and immunofluorescence assay; TUNEL staining was used to observe cell apoptosis in the thoracic aorta, and the expressions of caspase-3, Bax, and Bcl-2 were detected using Western blotting. The effects of intraperitoneal injections of 3-MA (an autophagy agonist), rapamycin (an autophagy inhibitor) or compound C 30 min before intermittent heat exposure on the expressions of proteins associated with autophagy, apoptosis and the AMPK/mTOR/ULK1 pathway in the aorta were examined with immunohistochemistry.

RESULTS

In SHR-8 group, the rats showed incomplete aortic intima with disordered cell distribution and significantly increased expressions of Beclin1, LC3II/LC3I and Bax, lowered expressions of p62 and Bcl-2, and increased apoptotic cells in the thoracic aorta (P < 0.05). Pretreatment with 3-MA obviously inhibited the expressions of autophagy- and apoptosis-related proteins, whereas rapamycin promoted their expressions. Compared with the control group, the rats in SHR-8 group had significantly down-regulated p-mTOR and up-regulated p-AMPK and p-ULK1 expression of in the aorta; Treatment with compound C obviously lowered the expressions of p-AMPK and p-ULK1 and those of LC3B and Beclin1 as well.

CONCLUSION

In SHRs, intermittent heat exposure causes significant pathologies and promotes autophagy and apoptosis in the thoracic aorta possibly by activating the AMPK/mTOR/ULK1 pathway.

Efficacy and Safety of Probiotics in Geriatric Patients with Constipation: Systematic Review and Meta-Analysis

BACKGROUND

Probiotics may be an effective alternative to traditional drug therapy for constipation in the elderly.

OBJECTIVE

To assess the efficacy and safety of probiotics in managing constipation among the elderly.

METHODS

Eight databases were queried for randomized controlled trials (RCTs) investigating probiotics' efficacy in addressing constipation among the elderly until January 2023. The meta-analysis was conducted employing R software version 4.2.2. The Cochrane risk of bias tool was utilized to evaluate the risk of bias, and the GRADE approach was employed to assess the credibility of the evidence concerning the efficacy of probiotics in treating constipation in older individuals.

RESULTS

A total of six RCTs involving 444 patients were included. Two studies were rated as low risk of bias. The meta-analysis findings revealed that probiotics, when compared to a placebo, led to an increase in stool frequency (MD = 1.02,95% CI [0.21, 2.07], p<0.05, very low quality), the probiotic group exhibited a notable impact on ameliorating symptoms associated with constipation (OR = 11.28, 95%CI [7.21, 17.64], p < 0.05, very low quality), no significant disparities were observed in terms of efforts to evacuate, manual maneuvers, and the incidence of adverse events (p>0.05).

CONCLUSION

The available evidence indicates a degree of uncertainty, ranging from low-to-very low, suggesting the efficacy of probiotics in augmenting bowel frequency and ameliorating constipation-related symptoms among elderly patients with constipation. Nevertheless, given the quality of the studies included, it is advisable to conduct further well-designed investigations with substantial sample sizes to substantiate the findings of this study.

Liraglutide alleviates vascular injury in diabetic rabbits with lower limb vascular stenosis through regulation of RCAN1

OBJECTIVE

The aim of the present study is to explore the possible mechanism that may have ameliorative effect of liraglutide (Lira) on diabetic lower extremity vascular stenosis.

MATERIALS AND METHODS

A diabetic rabbit model of lower extremity stenosis was established and treated with Lira. The intimal hyperplasia of the lower extremity and the oxidative stress level of vascular tissue were observed and examined. Vascular smooth muscle cells (VSMCs) induced by high glucose (HG) were treated with Lira, and RCAN1 overexpressing plasmid was constructed to transfect VCMCs.

RESULTS

Lira treatment showed its association in significantly improving the hyperplasia of the intima, the level of oxidative stress, and the level of homeostasis model assessment of insulin resistance (HOMA-IR) in rabbits induced by diabetes and lower limb stenosis. In addition, Lira treatment reduced the elevated expression of RCAN1 in vascular tissues induced by diabetes. Not only could Lira treatment inhibit the increase of ROS level, proliferation and migration of VSMCs induced by HG, but reduce the expression of PCNA, MMP-9 and collagen I induced by HG. Overexpression of RCAN1 in VSMCs counteracted the effect of Lira, suggesting that Lira affected the proliferation and migration of VSMCs by regulating RCAN1.

CONCLUSIONS

Our findings have important implications for Lira to exert beneficial outcomes in reducing excessive neointimal formation after lower extremity vascular injury in diabetic rabbits via the regulation of RCAN1.

[Practice and understanding of coronavirus disease 2019 epidemiological survey]

Epidemiological survey is a primary measure, following an epidemic detection and report, implemented by agencies for disease control and prevention according to law. It is the key to disposing coronavirus disease 2019 (COVID-19) epidemic and the premise of rapidly controlling this epidemic. In this paper, the essence and fundamental purpose of epidemiological survey in epidemic response was respectively attributed to emergency disposal and epidemic control. Fresh COVID-19 cases experienced by the author were used to introduce "limiting an epidemic to the minimum scale", on-site rapid disposal, developing and verifying a hypothesis, and report writing and suggest some challenges in the survey. This paper highlighted the role of on-site survey that should be not only investigating, but also hypothesizing and, in particular, rapidly disposing. The on-site experience and problems should be particularly transformed into strategies and measures for epidemic prevention and control in time. This paper also emphasized thinking of forming and perfecting the "evidence chain" by systematically checking and laying out the evidence, so as to serve verification of hypotheses. In the face of a once-in-a-century epidemic, extracting the valuable frontline experience of epidemiological survey would be helpful to accurately handle the epidemic situation, maintain the dynamic COVID-zero status, and respond to other major public health events in the future.

Percutaneous Intramyocardial Septal Radiofrequency Ablation in Patients With Drug-Refractory Hypertrophic Obstructive Cardiomyopathy

Importance

Patients with hypertrophic obstructive cardiomyopathy (HOCM) and drug-refractory symptoms and outflow gradients have limited nonsurgical treatment options. The feasibility of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) has been reported previously; however, procedural and medium-term outcomes are unknown.

Objective

To describe the safety and medium-term outcomes of PIMSRA in a large patient cohort with drug-refractory HOCM.

Design, Setting, and Participants

This was a single-arm, open-label study of PIMSRA in patients with drug-refractory HOCM. Patients presenting to the Xijing Hospital in Xi'an, China, between October 2016 to June 2020 with hypertrophic cardiomyopathy. Of 1314 patients presenting with HOCM, 244 fulfilled inclusion criteria of severe resting/provoked outflow gradients of 50 mm Hg or higher, and symptoms of New York Heart Association functional class of II or higher refractory to maximum tolerated medications. After discussion among the heart team, 40 patients underwent surgical or alcohol septal reduction therapy and 4 required treatment of significant coronary artery disease.

Interventions

PIMSRA performed in patients.

Main Outcomes and Measures

The primary outcome was 30-day major adverse clinical events: death, emergency surgery, severe effusion requiring intervention, procedure-related stroke, bleeding, and stroke. Secondary outcomes included 30-day technical success and 90-day improvement in outflow obstruction.

Results

The mean (SD) age of 200 patients was 46.9 (14.0) years, and 125 (62.5%) were men. Resting or provoked left ventricular outflow tract gradients were 50 mm Hg or higher. The median (IQR) follow-up for all patients was 19 (6-50) months. Thirty-day major adverse clinical events rate was 10.5% (n = 21): there were 2 in-hospital/30-day deaths (1.0%), 7 patients (3.5%) with pericardial effusion requiring mini-thoracotomy, 12 patients (6%) with pericardial effusion requiring pericardiocentesis, and no bleeding or strokes. Other periprocedural complications included permanent right bundle branch block in 5 patients (2.5%), resuscitated ventricular fibrillation in 2 (1.0%), and septal branch aneurysm in 2 (1.0%). There were no permanent pacemaker implantations. At follow-up, maximum septal thickness was reduced from a mean (SD) of 24.0 (5.1) mm to 17.3 (4.4) mm (P < .001), and left ventricular outflow tract gradient was decreased from a mean (SD) of 79.0 (53.0) mm Hg to 14.0 (24.0) mm Hg (P < .001). Overall, 190 patients (96%) with HOCM were in New York Heart Association functional class I or II at last follow-up.

Conclusions and Relevance

This study found that PIMSRA in patients with drug-refractory HOCM may be an effective procedure for relief of left ventricular outflow tract obstruction and symptoms with acceptable complication rates. These results are encouraging and support the design of a randomized clinical trial against well-established septal reduction therapies.

Application of the research electronic data capture (REDCap) system in a low- and middle income country- experiences, lessons, and challenges

The challenges of reliably collecting, storing, organizing, and analyzing research data are critical in low- and middle-income countries (LMICs), particularly in Sub-Saharan Africa where several healthcare and biomedical research organizations have limited data infrastructure. The Research Electronic Data Capture (REDCap) System has been widely used by many institutions and hospitals in the USA for data collection, entry, and management and could help solve this problem. This study reports on the experiences, challenges, and lessons learned from establishing and applying REDCap for a large US-Nigeria research partnership that includes two sites in Nigeria, (the College of Medicine of the University of Lagos (CMUL) and Jos University Teaching Hospital (JUTH)) and Northwestern University (NU) in Chicago, Illinois in the United States. The largest challenges to this implementation were significant technical obstacles: the lack of REDCap-trained personnel, transient electrical power supply, and slow/intermittent internet connectivity. However, asynchronous communication and on-site hands-on collaboration between the Nigerian sites and NU led to the successful installation and configuration of REDCap to meet the needs of the Nigerian sites. An example of one lesson learned is the use of Virtual Private Network (VPN) as a solution to poor internet connectivity at one of the sites, and its adoption is underway at the other. Virtual Private Servers (VPS) or shared online hosting were also evaluated and offer alternative solutions. Installing and using REDCap in LMIC institutions for research data management is feasible; however, planning for trained personnel and addressing electrical and internet infrastructural requirements are essential to optimize its use. Building this fundamental research capacity within LMICs across Africa could substantially enhance the potential for more cross-institutional and cross-country collaboration in future research endeavors.

A microporous anionic metal–organic framework for aqueous encapsulation and highly reversible sensitization of light-emitting Tb3+ ions

An anionic porous material can serve as both a host and an antenna for protecting and sensitizing extra-framework light-emitting Eu3+/Tb3+ ions. The Tb3+ uptake and release is a reversible process and the cationic Tb3+ can be gradually released.

The factors involved in the induction of neutrophil gelatinase-associated lipocalin overexpression in renal tubular epithelial cells under endoplasmic reticulum stress

Our previous work found that neutrophil gelatinase-associated lipocalin (NGAL) expression increases when endoplasmic reticulum stress (ERS) occurs in human kidney-2 (HK-2) tubular epithelial cells. However, the reason for this is not yet known. This study investigated the factors involved when inducing NGAL overexpression in HK-2 cells during ERS. The cells were divided into six groups: the control group (normal HK-2 cells), the ERS group (HK-2 cells cultured in complete medium with thapsigargin (TG)), the transfection group (HK-2 cells transfected with activating transcription factor 4 small interfering ribonucleic acid (ATF4 siRNA), the ERS after transfection group (HK-2 cells transfected with ATF4 siRNA, then cultured in complete medium with TG), the negative control group (HK-2 cells transfected with siRNA-negative contrast), and the dimethyl sulfoxide (DMSO) group (HK-2 cells cultured in complete medium with DMSO). Western blot and a real-time polymerase chain reaction were used to measure the expression of protein and messenger ribonucleic acid (mRNA). As a result NGAL, ATF4, C/EBP homologous protein, glucose-regulated protein 78 kDa, ATF4 mRNA, and NGAL mRNA were clearly overexpressed in the ERS group compared with the control group (p < 0.05). The expression of NGAL and ATF4 were similar in the control group, the negative control group, and the DMSO group (p > 0.05). Meanwhile, ATF4, NGAL, ATF4 mRNA, and NGAL mRNA in the ERS after transfection group were significantly lower compared with the ERS group (p < 0.05), which showed that NGAL was affected by ATF4. There was a close correlation between NGAL and ATF4; when the expression of ATF4 was inhibited, NGAL was significantly lower. Therefore, ATF4 may be one of the upstream regulators of NGAL.

[Mesenchymal Stem Cells Cultured in 3D System Inhibit Non-small Cell Lung Cancer Cells Through p38 MAPK and CXCR4/AKT Pathways by IL-24 Regulating]

Non-small cell lung cancer (NSCLC) is prevalent worldwide and has a high mortality rate. Even if mesenchymal stem cells (MSCs) are suggested as cancer treatment, the studies of their effects on NSCLC cells contradict each other, mainly due to utilization of two-dimensional (2D) culture system. Three-dimensional (3D) culture systems resemble tissue organization in vivo. Here we comprehensively explore the inhibitory effects of MSCs on NSCLC cells in a 3D culture system. We confirmed that the inhibitory effects of 3D-cultured MSCs (3D-MSCs) on the proliferation and migration of NSCLC cells are greater than that of the 2D-cultured MSCs. 3D-MSCs overexpress IL-24, which serve as the key factor enhancing antitumor effects of MSCs. In these cells, IL-24 affects p38 MAPK and CXCR4/AKT pathways. Overall, this study provides the support for use of MSCs in tumor.

Ginseng berry concentrate prevents colon cancer via cell cycle, apoptosis regulation, and inflammation-linked Th17 cell differentiation

The Asian ginseng root (Panax ginseng C.A. Meyer) is a very commonly used herbal medicine worldwide. Ginseng fruit, including the berry (or pulp) and seed, is also valuable for several health conditions including immunostimulation and cancer chemoprevention. In this study, the anticancer and anti-proliferative effects of the extracts of ginseng berry and seed were evaluated. The ginsenosides in the ginseng berry concentrate (GBC) and ginseng seed extract (GSE) were analyzed. We then evaluated their anti-colorectal cancer potentials, including antiproliferation, cell cycle arrest, and apoptotic induction. Further investigation consisted of the berry's adaptive immune responses, such as the actions on the differentiation of T helper cells Treg, Th1, and Th17. The major constituents in GBC were ginsenosides Re and Rd, which can be compared to those in the root. The GBC significantly inhibited colon cancer cell growth, and its anti-proliferative effect involved mechanisms including G2/M cell cycle arrest via upregulation of cyclin A and induction of apoptosis via regulation of apoptotic related gene expressions. GBC also downregulated the expressions of pro-inflammatory cytokine genes. For the adaptive immune responses, GBC did not influence Th1 and Treg cell differentiation but significantly inhibited Th17 cell differentiation and thus regulated the balance of Th17/Treg for adaptive immunity. Although no ginsenoside was detected in the GSE, interestingly, it obviously enhanced colon cancer cell proliferation with the underlined details to be determined. Our results suggested that GBC is a promising dietary supplement for cancer chemoprevention and immunomodulation.

Expression of ICAM-1 in placental tissues and the association between its gene polymorphisms and pathogenesis of preeclampsia

OBJECTIVE

The aim of this study was to explore the expression of intercellular adhesion molecule-1 (ICAM-1) in placental tissues of patients with preeclampsia, and to elucidate the association between its polymorphisms and pathogenesis of preeclampsia.

PATIENTS AND METHODS

A total of 100 preeclampsia patients (Preeclampsia group) and 100 normal puerperae (Control group) were selected as research objects. The protein expression of ICAM-1 in placental tissues was detected via Western blotting and immunohistochemical staining. The single nucleotide polymorphisms (SNPs) rs134568, rs128343, and rs201931 in the promoter region of ICAM-1 were typed via conformation difference gel electrophoresis. Chi-square test was used to detect whether the distribution frequency of ICAM-1 genotype was in agreement with Hardy-Weinberg equilibrium. The associations of ICAM-1 alleles and polymorphic sites with pathogenesis of preeclampsia were analyzed as well. Finally, the correlation between GG genotype of ICAM-1 rs134568 and clinicopathological features of preeclampsia was analyzed.

RESULTS

The protein expression of ICAM-1 in placental tissues was significantly higher in Preeclampsia group than that in Control group (p<0.05). ICAM-1 SNPs rs134568, rs128343 and rs201931 all met Hardy-Weinberg equilibrium (p>0.05). According to gene correlation analysis, ICAM-1 rs134568 polymorphism and alleles were associated with the pathogenesis of preeclampsia (p<0.05). However, ICAM-1 rs128343 and rs201931 polymorphisms and alleles had no associations with the pathogenesis of preeclampsia (p>0.05). Besides, systolic blood pressure, serum creatinine level and plasma albumin level showed no statistically significant differences between people with GG genotype of ICAM-1 rs134568 in Preeclampsia group and those in Control group (p>0.05).

CONCLUSIONS

ICAM-1 expression increased significantly in placental tissues of patients with preeclampsia. In addition, rs134568 in the promoter region of ICAM-1 was associated with the pathogenesis of preeclampsia.

Multimorbidity patterns in old adults and their associated multi-layered factors: a cross-sectional study

BACKGROUND

Influenced by various factors such as socio-demographic characteristics, behavioral lifestyles and socio-cultural environment, the multimorbidity patterns in old adults remain complex. This study aims to identify their characteristics and associated multi-layered factors based on health ecological model.

METHODS

In 2019, we surveyed a total of 7480 participants aged 60+ by using a multi-stage random cluster sampling method in Shanxi province, China. Latent class analysis was used to discriminate the multimorbidity patterns in old adults, and hierarchical regression was performed to determine the multi-layered factors associated with their various multimorbidity patterns.

RESULTS

The prevalence of multimorbidity was 34.70% among the old patients with chronic disease. Over half (60.59%) of the patients with multimorbidity had two co-existing chronic diseases. "Degenerative/digestive diseases", "metabolic diseases" and "cardiovascular diseases" were three specific multimorbidity patterns. Behavioral lifestyles-layered factors had the most explanatory power for the three patterns, whose proportions of explanatory power were 54.00, 43.90 and 48.15% individually. But the contributions of other multi-layered factors were different in different patterns; balanced diet, medication adherence, the size of family and friendship network, and different types of basic medical insurance might have the opposite effect on the three multimorbidity patterns (p < 0.05).

CONCLUSIONS

In management of old patients with multimorbidity, we should prioritize both the "lifestyle change"-centered systematic management strategy and group-customized intervention programs.

[The application of continuous glucose monitoring in the management of hepatic glycogen storage disease]

Objective: Continuous glucose monitoring (CGM) were performed in children with hepatic glycogen storage disease (GSD) to accurately understand the situation of glucose levels during their treatment, and to provide support for optimizing their nutritional management. Methods: In this retrospective research, 42 patients with hepatic GSD who under went 72 h CGM were collected from Department of Pediatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology from October 2019 to January 2020. According to the genetic test results, they were divided into 5 groups: type Ⅰa, type Ⅰb, type Ⅲa, type Ⅵ and type Ⅸa. After long-term follow up and regular treatment, the clinical data (induding course, age, height, weight and biochemical parameters, etc.) on the day of CGM were summarized, and 72 h CGM were performed to assess the occurrence of hypoglycemia and hyperglycemia.χ² test, Fisher exact probability method, t test, analysis of variance or nonparametric test were used for comparison between groups. Results: Forty-two cases of hepatic GSD patients included 25 males and 17 females (20 cases of type Ⅰa, 3 cases of type Ⅰb, 10 cases of type Ⅲa, 3 cases of type Ⅵ and 6 cases of type Ⅸa).The age was 9.5 (6.7, 12.9) years, and the course of disease was 6.8 (5.1, 11.3) years. The average levels of glucose of the patients were all normal. However, the levels of standard deviation of blood glucose (SDBG) and mean amplitude of glycemic excursion (MAGE) were significantly different (F=2.747, 3.029,both P<0.05). Among them, the SDBG of type Ⅰa and Ⅲa were significantly higher than those of type Ⅸa ((1.10±0.36), (0.98±0.30) vs. (0.62±0.26) mmol/L, t=3.010, 2.440, both P<0.05), while the MAGE of type Ⅰ was higher than that of Ⅸa and Ⅲa ((2.3±0.9) mmol/L vs. (1.2±0.6) and (1.7±0.6) mmol/L, t=2.734, 2.302, both P<0.05, respectively). Conclusions: CGMS can accurately assess the fluctuations of blood glucose and effectively detect hidden hypoglycemia and hyperglycemia in hepatic GSD patients. For different types of hepatic GSD, individualized corn starch treatment doses should be given according to the different situation of blood glucose, so as to optimize the patient's treatment and improve their prognosis.

Exploring the influencing factors of quality of life among the empty nesters in Shanxi, China: a structural equation model

Background

As China’s aging trend intensifies and the proportion of empty nests increases, the health-related quality of life of the elderly is the focus of social attention. Previous studies focused on the quality of life of the elderly, rather than empty nesters, and lacked the discussion of the mechanism of influencing factors. Thus, this study aimed to explore the influencing factors of the quality of life (QOL) and interaction mechanisms among empty nesters in Shanxi Province, China, so as to provide practical reference for improving the QOL of empty nesters.

Methods

A total of 4901 empty nesters in Shanxi Province, China, were selected using multi-stage random cluster sampling method in this cross-sectional study. The quality of life was assessed with the Short Form 36 Health Survey (SF-36). Multiple linear regression analysis (stepwise) was performed to examine the factor associated with QOL. Structural equation model (SEM) approach was conducted to test the direct and indirect association between QOL influencing factors with QOL.

Results

The average QOL score of empty nesters was 63.34 (SD = 17.23). The multiple linear regression revealed that gender, age, education, monthly income, drinking status, exercise frequency, physical examination frequency, attention to daily nutritional health, relationship with a spouse and relationship with children were significant predictors of the empty nester’s QOL (P < 0.05) (R² = 0.128). SEM showed that behavioral lifestyle had a direct effect on QOL (β = 0.446, P < 0.001). Socio-economic status had an indirect effect (β = 0.288, P < 0.001) on QOL through behavioral lifestyle. The family relationship had an indirect effect (β = 0.115, P < 0.001) on QOL.

Conclusion

Behavioral lifestyle was the strongest influencing factor in the quality of life among empty nesters, followed by socio-economic status and family relationships. Thus, maintaining a healthy behavioral lifestyle was important to improve the QOL of the empty nesters. Our findings provide a concrete and strong reference for the formulation of targeted intervention strategies.

Long noncoding RNA SLC30A10 promotes colorectal tumor proliferation and migration via miR-21c/APC axis

OBJECTIVE

Colorectal cancer is a common malignancy and a common cause of tumor-related death. Long non-coding RNAs (lncRNAs) have become an important regulatory factor and tissue specific biomarker for a variety of cancers, including colorectal cancer. Recent evidence indicates that the novel lncRNA SLC30A10 plays an important role in tumor progression and metastasis. However, its role and molecular mechanisms in colorectal cancer are unclear.

PATIENTS AND METHODS

SLC30A10 expression was detected in 12 colorectal cancer and adjacent normal tissues by quantitative reverse transcription PCR. Insights into the underlying mechanisms of competitive endogenous RNAs (ceRNAs) were determined by transwell assay, CCK8 assay, and luciferase assay.

RESULTS

SLC30A10 was down-regulated in colorectal cancer tissues and cell lines, and its low expression was positively correlated with colorectal cancer progression and metastasis. Functionally, SLC30A10 depletion promotes cell proliferation and migration in colorectal cancer cells, while SLC30A10 overexpression has the opposite effect. Bioinformatics prediction and luciferase assay indicated that miR-21c is a direct target of SLC30A10, which plays the role of ceRNA in regulating colorectal cancer metastasis. In addition, miR-21c specifically targets APC gene.

CONCLUSIONS

Our findings suggest that reduced expression of SLC30A10 is associated with aggressive tumor phenotypes and poor patient outcomes in colorectal cancer. SLC30A10 inhibits colorectal cancer progression and metastasis by acting as a ceRNA for miR-21c to regulate APC expression, suggesting that SLC30A10 may serve as a potential prognostic biomarker and anti-metastatic therapeutic target for colorectal cancer.

Cohort Profile: West China Health and Aging Trend (WCHAT)

OBJECTIVES

The West China Health and Aging Trends study (WCHAT) is intended to focus on the research that will guide efforts to reduce disability, maximize health and independent functioning, and enhance quality of life at older ages in different ethnicities. And provide the basis for understanding trends and dynamics in late-life functioning, how these differ in various ethnic subgroups, and the economic or social consequences of aging and disability in western China.

PARTICIPANTS

The cohort enrolled 7536 participants and 7439 participants aged 50 years and older in the baseline in 2018 and every year would be followed up. Finding to date: The data in WCHAT were prospectively collected from Yunnan, Guizhou, Sichuan and Xinjiang by 7 medical institutions. A number of age-related outcome measures were collected though corresponding geriatric assessments. Blood testing, saliva, urine and feces testing are available for all cohort participants. Future plans: The data in WCHAT can be used for various types of epidemiological research, particularly for examining how the culture specific life styles and diet influences geriatrics related outcomes. We are initially planning cohort studies and established a sample biobank in relation to the risk and prognosis of frailty, sarcopenia and other geriatric syndromes. Strengths and limitations of this study: It is a first multi-ethnic cohort study in West China that aimed to investigate the influence of culture specific life styles, diet and living environment on the prevalence of geriatric syndromes like frailty, sarcopenia and so on. This is a prospective multi-center observational study, which will be conducted in various ethnic groups gathering places. This study collected information that related to fatigue, falls, and cognition were obtained through self-reports, which might have recall bias and grouping errors. This study has problems such as the interviewees' refusal to visit, death, going out, and large population mobility may lead to high loss of visit rates. This study collected information from a comparatively healthier elderly population in which external validity was limited.

The Relationship between Sarcopenia and Vitamin D Levels in Adults of Different Ethnicities: Findings from the West China Health and Aging Trend Study

OBJECTIVES

Sarcopenia is a condition associated with progressive loss of skeletal muscle mass and function resulting in substantial negative health outcomes and disability in older adults. It is thus important that sarcopenia-related risk factors be explored. The present study was based upon the Asian Working Group on Sarcopenia 2019 (AWGS2019) criteria to assess whether vitamin D levels are a risk factor associated with sarcopenia in various ethnic groups in western China.

DESIGN

Cross-sectional study.

SETTING

Communities in Yunnan, Guizhou, Sichuan, and Xinjiang provinces.

PARTICIPANTS

We included 4236 individuals that were 50 years of age or older from the West China Health and Aging Trend (WCHAT) study.

MEASUREMENTS

An InBody 770 instrument was used for bioimpedance-based analyses of muscle mass, while a digital grip strength dynamometer was used for handgrip strength-based measurements of muscle strength. Physical performance was assessed based upon gait speed over 4 m. Other secondary variables were additionally analyzed as potentially relevant risk factors.

RESULTS

Sarcopenia affected an estimated 22.45% of studied individuals who were 50 years of age or older, with respective prevalence rates in the < 60, 60-64, 65-79, and ≥80 age groups of 11.78%,19.44%, 32.65%, and 67.97%. Rates in males and females were 26.66% and 20.05%, respectively. In males, a significant difference in vitamin D levels was detected when comparing individuals with and without sarcopenia, although no such relationship was detected in females. Following adjustment for confounding variables, binary logistic regression analyses revealed that inadequate vitamin D was able to independently predict sarcopenia risk only in males (OR=1.875,95%CI: 1.109-3.169, P=0.019).

CONCLUSIONS

Among middle-aged and older adults of multiple ethnicities in western China, we found that inadequate vitamin D was an independent predictor of sarcopenia risk specifically in males.

Associations of Body Mass Index, Visceral Fat Area, Waist Circumference, and Waist-to-Hip Ratio with Cognitive Function in Western China: Results from WCHAT Study

OBJECTIVES

This study examined the relationship between cognitive performance and obesity parameters, such as body mass index (BMI), visceral fat area (VFA), waist circumference (WC), and waist-to-hip ratio (WHR) in western China.

STUDY DESIGN

A cross-sectional study.

METHODS

3914 participants, aged ≥50 years, were recruited in this study. Anthropometrics measurements, life-style factors, chronic disease comorbidities, and sleep qualities were recorded for each participant. Among the anthropometrics, BMI, WC, and WHR were assessed using standard procedures, while VFA was calculated using bioelectrical impedance analysis. Cognitive performance was estimated using the Short Portable Mental Status Questionnaire (SPMSQ). Finally, relationships between cognitive abilities and BMI, VFA, WC, and WHR were evaluated using univariate and multivariate regression analyses.

RESULTS

Cognitive decline (CD) occurred at a rate of 13.29% among the 3914 participants. A strong correlation was observed between cognitive abilities and BMI of male patients aged 50-59 yrs (OR 1.116,95% CI1.002-1.242), in the adjusted model. Alternately, WHR was shown to be significantly related to CD in females aged ≥70 years (OR 0.041, 95% CI0.002-0.671). WC was shown to have a strong association with CD in males (OR 1.023,95% CI1.003-1.024). Lastly, WHR was closely connected to CD in participants with BMI < 25 kg/m2 (OR 0.022,95% CI0.002-0.209).

CONCLUSIONS

Our findings suggest that a higher middle age BMI is associated with CD, whereas, in the elderly population, a higher WHR is related to improved cognitive performance. Further investigation is warranted to elucidate a relationship between VFA and CD.

The Role of Baseline Sarcopenia Index in Predicting Chemotherapy-Induced Undesirable Effects and Mortality in Older People with Stage III or IV Non-Small Cell Lung Cancer

OBJECTIVES

To assess the predictability value of Sarcopenia index( (SI, serum creatinine value/cystatin C value×100) in determining potential chemotherapy-induced undesirable reactions and eventual death of older patients diagnosed with stage III or IV of non-small cell lung cancer (NSCLC).

METHODS

General information was retrieved from health records and mortality data was obtained by phone interview. Serum Cr and CysC levels were measured before chemotherapy. The endpoints recorded were chemotherapy-induced undesirable reactions and mortality from any causes. Logit regression analysis was employed for the analysis of correlation between the SI and short-term adverse reactions to chemotherapy. Cox regression analysis was employed to analyze correlation between the SI and mortality.

RESULTS

In this study, 664 NSCLC patients were enrolled. Among them, 83.13% were diagnosed with adenocarcinoma lung cancer and 16.87% with squamous cell carcinoma lung cancer. As of March 1, 2019, 486 patients died, including 361(74.28%) males and 125 (25.72%) females. After the first course of chemotherapy, the proportion of short-term adverse reactions, including bone marrow suppression, digestive reactions, all infection, liver function impairment, and other adverse reactions (non-infectious fever or rashes) was 16%, 4.7%, 7.4, %, 6.6%, and 2.11%, respectively. After adjusting for confounding factors, there was no association between the SI and adverse reactions. We found that high SI was independently associated with a lower risk of mortality after adjusting for confounding factors in females (HR=0.593,95% CI: 0.382-0.92; p=0.02). There was no marked association existed between the SI and mortality in males.

CONCLUSION

Among patients with stage III or IV non-small cell lung cancer, the SI is associated with mortality in females, but not in males.

Comorbid Depressive Symptoms, Visual Impairment, and Sarcopenia among Middle-Aged and Older Women: Findings from the West China Health and Aging Trend study

Previous reports have described close relationships between sarcopenia and either visual impairment or depression, but there have been few analyses investigating the association between sarcopenia and the coexistence of both visual impairment and depression. Herein, we sought to explore the associations between sarcopenia and comorbid depressive symptoms and visual impairment among older females. A cross-sectional analysis of females between the ages of 50 and 95 (n = 2454) from the West China Health and Aging Trend (WCHAT) study was conducted. Patient muscle mass was assessed via a bioimpedance-based approach using an InBody 770 device, while muscle strength was estimated based on handgrip strength as quantified with a digital grip strength dynamometer. Depressive systems were evaluated with the 15-item Geriatric Depression Scale (GDS-15), and a questionnaire was employed to evaluate patient visual functionality. Associations between sarcopenia and comorbid depressive status and visual impairment were explored through logistic regression analyses. Comorbid depressive symptoms and visual impairment were observed in 6.2% of the women included in this study, while 18.9% suffered from sarcopenia. Following adjustment for covariates, relative to normal controls, study subjects with only depression (OR=1.45, 95%CI=1.04-2.02), only visual impairment (OR=1.69, 95%CI=1.27-2.26), or comorbid depression and visual impairment (OR=1.76, 95% CI=1.16-2.67) exhibited a higher risk of sarcopenia. These results suggest that comorbid depression and visual impairment are linked to the prevalence of sarcopenia in older Chinese women. As such, further efforts to screen older women for these two comorbid conditions may thus be necessary.

The Relationship between Pre-Admission Waiting Time and the Surgical Outcomes after Hip Fracture Operation in the Elderly

OBJECTIVES

To investigate the association between pre-admission waiting time and postoperative complications, length of stay (LOS), and costs during hospitalization.

METHOD

This was a single-center, observational study. The subjects of this study were elderly hip fracture patients who were admitted to the Department of Orthopedics, West China Hospital, Sichuan University, from December 2010 to June 14, 2017, and that underwent internal fixation or joint replacement surgery. The pre-admission waiting time was treated as a categorical variable according to median and first quartile values. Outcomes included postoperative complications (pneumonia and other complications [urinary tract infection, heart failure, non-A-grade healing]), LOS, and costs during hospitalization. LOS and costs during hospitalization were converted into binary outcomes based upon median values. Binary logistic regression analyses were used to analyze correlations between pre-admission waiting time and patient outcomes.

RESULTS

A total of 889 patients 60 years of age and older were enrolled in this study, of whom 65.47% were females and 34.53% were males. The proportion of patients with pre-admission waiting times less than 8 h, 8 - 24 h, and ≥ 24 h were 24.3%, 17.32%, and 58.38%, respectively. Postoperative pneumonia and other complications affected 12.04% and 6.30% of patients, respectively. Relative to patients with the pre-admission waiting times of less than 8 h, those with longer pre-admission waiting times exhibited a higher risk of postoperative pneumonia (8 - 24 h: OR = 2.72,95% CI: 1.29-5.74, p = 0.009; ≥ 24 h: OR = 2.76,95% CI: 1.48-5.14, p = 0.001). Patients with the pre-admission waiting time ≥ 24 h also exhibited a higher risk of the other complications (OR = 2.55, 95% CI: 1.53-4.26, p <0.001), a longer LOS (OR = 1.43, 95% CI:1.02-2.01, p = 0.036), and higher costs during hospitalization (OR = 1.51, 95% CI:1.05 - 2.17, p = 0.026) relative to patients with a waiting time less than 8 hours.

CONCLUSION

Pre-admission waiting time was associated with postoperative complications, LOS, and hospitalization costs among older Chinese patients undergoing surgery to treat hip fractures.

The Combined Effect of Hearing Impairment and Cognitive Impairment with Health-Related Outcomes in Chinese Older People

OBJECTIVES

To determine the risk of poor health-related outcomes in older adults with cooccurring hearing impairment and cognitive impairment, and to compare the risk of hearing impairment only, cognitive impairment only, and multiple morbidities.

DESIGN

Cross-sectional study.

SETTING

Community-dwelling older adults aged 60 years and older were included.

PARTICIPANTS

The data of missing hearing and cognitive status were excluded, and 3770 older people participated in the study.

MEASUREMENTS

The hearing function evaluation was conducted by questionnaire survey. Assessment of cognitive function was completed using the SPMSQ scale. The subjects were divided into hearing impairment and cognitive impairment group, hearing impairment only group, cognitive impairment only group and neither group. Multiple logistic regression was used to analyze the risks of hearing and cognitive impairment and health-related condition.

RESULTS

The prevalence of hearing impairment and cognitive impairment, hearing impairment only, cognitive impairment only, and neither were 9.4%, 8.3%, 29.9% and 52.4%, respectively. Compared with the control group, the individuals with hearing impairment and cognitive impairment were associated with depression (OR=3.48, 95% CI=2.66, 4.56), anxiety (OR=2.35, 95% CI=1.92, 3.33), frailty (OR=4.30, 95% CI=2.89, 6.40), and ADL impairment (OR=2.77, 95% CI=2.03, 3.77).

CONCLUSION

The studies shows that hearing impairment combined with cognitive impairment is significantly associated with anxiety, depression, frailty, and ADL impairment. Comprehensive management and intervention should be provided for older people to reduce the occurrence of adverse health consequences.

Analysis of the Prevalence of Sarcopenia and Its Risk Factors in the Elderly in the Chengdu Community

OBJECTIVE

To understand the prevalence of sarcopenia in the Chengdu community, analyze the risk factors of sarcopenia, and provide a theoretical basis for further development of strategies for sarcopenia prevention and treatment.

METHODS

A total of 938 individuals aged 60 years and above were recruited from the community of Chengdu. Skeletal muscle mass was measured by the bioelectrical impedance analysis (BIA), and sarcopenia was diagnosed according to the Asian Sarcopenia Working Group (AWGS) 2019 diagnostic criteria. A scale was generated to determine the age, living habits, and chronic diseases of enrolled subjects. The Mini Mental Examination Scale (MMSE) was used to assess their cognitive function, and the Geriatric Depression Scale (GDS-15) was used to identify depression.

RESULTS

Among the 938 residents enrolled in the study, 172 (18.34%) had sarcopenia, including 48 (5.12%) with severe sarcopenia. The prevalence of sarcopenia in males was 19.91% and 16.81% in females. According to the binary logistic regression, older age (OR = 1.104, 95%CI: 1.059-1.151) and impaired cognitive function (OR = 2.251, 95%CI: 1.145-4.424) were independent risk factors for sarcopenia in females. Among the males, older age (OR = 1.079, 95%CI: 1.037-1.124) was the independent risk factor for sarcopenia. A moderate increase in BMI reduced the prevalence of sarcopenia in both females and males. Multi-category logistic regression analysis documented that females of older age were more likely to develop severe sarcopenia (χ2 = 16.769, P < 0.01 vs. no sarcopenia), females with lower BMI were more likely to develop severe sarcopenia (χ2 = 13.654, P < 0.01 vs. no sarcopenia), females with heart disease were more likely to develop severe sarcopenia (χ2 = 5.786, P = 0.016 vs. no sarcopenia; χ2 = 5.791, P = 0.016 vs. non-severe sarcopenia), and females with impaired cognitive function were more likely to develop severe sarcopenia (χ2 = 13.381, P < 0.01 vs. no sarcopenia; χ2 = 7.529, P = 0.006 vs. non-severe sarcopenia). Males were more likely to develop severe sarcopenia with older age (χ2 = 18.435, P < 0.01 vs. no sarcopenia; χ2 = 9.8011, P=0.002 vs. non-severe sarcopenia), lower BMI (χ2 = 12.736, P < 0.01 vs. no sarcopenia), smoking (χ2 = 4.68, P = 0.031 vs. no sarcopenia; χ2 = 5.652, P = 0.017 vs. non-severe sarcopenia), and chronic obstructive pulmonary disease (COPD) (χ2 = 5.517, P = 0.019 vs. no sarcopenia).

CONCLUSION

In the Chengdu community, the prevalence of sarcopenia among individuals 60 years of age or older was higher in males than in females. In elderly females, older age and impaired cognitive function were independent risk factors for sarcopenia. Women with more advanced age, decreased BMI, heart disease, and impaired cognitive function were more likely to develop severe sarcopenia. In elderly males, increased age was an independent risk factor for sarcopenia, and older age, decreased BMI, smoking, and COPD increased the probability of developing severe sarcopenia.

Improvement of social support in empty-nest elderly: results from an intervention study based on the Self-Mutual-Group model

BACKGROUND

China has the world's largest elderly population and an increasing number of empty-nest elderly. The purpose of this study is to evaluate the effectiveness of the Self-Mutual-Group model on social support of the empty-nest elderly, thus providing reference for improving their quality of life.

METHODS

A intervention study was conducted between October 2016 and May 2017 at six communities in Taiyuan, Shanxi Province, China. A total of 350 empty-nest elderly aged 60-88 years were randomly assigned in the intervention group (n = 167) with a 7-month SMG-based intervention or to a control group (n = 183) with no intervention. The social support of the participating elderly (n = 350) was assessed by the Social Support Rating Scale (SSRS) at the baseline and 7 months later, respectively.

RESULTS

A 7-month follow-up showed an increasing mean scores of SSRS, objective support, subjective support and support utilization of the intervention group, and reached statistical significance (P < 0.05).

CONCLUSIONS

The Self-Mutual-Group model was considered to be a positive intervention and was effective in increasing social support among the empty-nest elderly. Furthermore, future research should extend the intervention period and introduce multi-point measurement to better evaluate the intervention process and outcomes.

TRIAL REGISTRATION

Study on the 'SMG' Health Management Model Based on Community Organization Theory among empty-nest elderly (ChiCTR1800015884).

Combined Effect of Osteoporosis and Poor Dynamic Balance on the Incidence of Sarcopenia in Elderly Chinese Community Suburban-Dwelling Individuals

OBJECTIVES

Given the increasing prevalence of osteoporosis and the important role dynamic balanced plays in the assessment of muscle function, we aimed to examine the joint and separate effects of osteoporosis and poor dynamic balance on the incidence of sarcopenia in Chinese elderly individuals.

DESIGN

This study was conducted on 658 (44.4% male) Chinese suburban-dwelling participants with a mean age of 68.42 ± 5.43 years who initially had no sarcopenia and were aged ≥60 years. A quantitative ultrasound scan of each participant's calcaneus with a T score less than -2.5 was used to identify the prevalence of osteoporosis. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia criteria. We assessed dynamic balance using the Timed Up and Go Test (TUGT). Participants who scored in the top 20% on the TUGT were defined as having poor dynamic balance.

RESULTS

After a follow-up of three years, the incidence of sarcopenia in the general population was 8.1% (9.6% in males, 6.8% in females). The incidence of sarcopenia was progressively greater in people suffering from both osteoporosis and poor dynamic balance (OR=2.416, 95%CI=1.124-5.195) compared to those who only had osteoporosis (OR=0.797, 95%CI=0.378-1.682) or poor dynamic balance (OR=1.226, 95%CI=0.447-3.363) in models without adjustments. Even after adjusting for potential confounders, the result still held true (OR=2.431, 95%CI=1.053-5.614).

CONCLUSIONS

In our study, we found individuals who suffered from both osteoporosis and poor dynamic balance simultaneously had a significantly higher incidence of sarcopenia than those who suffered from either one or the other.

Sensory Impairment and All-Cause Mortality Among the Oldest-Old: Findings from the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

OBJECTIVES

To investigate the association between sensory impairment and all-cause mortality among the oldest-old (aged 80 and older) in China.

DESIGN

Prospective cohort study.

SETTING

Community-based setting in 22 provinces of China.

PARTICIPANTS

A total of 8788 older adults aged 80 and over at baseline with complete hearing and vision function data were included as the study population.

MEASUREMENTS

Sensory impairment was categorized as no sensory impairment, hearing impairment (HI) only, vision impairment (VI) only and dual sensory impairment (DSI) according to hearing and vision function. Deaths were identified through interviews by close family members. Cox proportion hazards regression models were used to examine the association of sensory impairment with mortality, adjusting for socio-demographic data, life style factors and health status.

RESULTS

The mean age was 92.3 ± 7.6 years old, and 60.1% of participants were female. Among 8788 participants, 9.8% were recognized as DSI, 9.7% were HI only and 10.4% with VI only. Comparing with participants with no sensory impairment, those with VI only (HR=1.10, 95% CI=1.01-1.20) and DSI (HR=1.21, 95% CI=1.09-1.35) were significantly associated with higher risk of all-cause mortality in the fully adjusted model.

CONCLUSION

Our results demonstrated that VI only and DSI were significantly associated with higher risk of mortality among Chinese older adults aged 80 and over. The finding advocated that it is necessary to identify and manage sensory impairments for the advanced ages to reduce mortality risks.

Ethnic Groups Differences in the Prevalence of Sarcopenia Using the AWGS Criteria

OBJECTIVES

To estimate the prevalence of sarcopenia in different ethnic groups and the association with cultural life styles in west China.

DESIGN

A cross-sectional study.

SETTINGS

The communities in Yunnan, Guizhou, Sichuan, and Xinjiang provinces.

PARTICIPANTS

4500 participants aged 50 years or older in west China were enrolled in this study. Sarcopenia was defined according to the diagnostic algorithm of the Asia Working Group for Sarcopenia (AWGS).

MEASUREMENTS

We measured gait speed, handgrip strength and muscle mass by using bioelectrical impedance analysis (BIA) for all eligible participants. Life-style information were collected by reviewers. Relationships between sarcopenia and ethnic groups were analyzed using univariate and multivariate analyses.

RESULTS

We found 869 (19.31%) adults aged 50 years old or older were sarcopenia. The mean age is 62.4±8.3 years. The main ethnic groups enrolled in this study is Han, Tibetan, Qiang, Yi and Hui. The crude prevalence of sarcopenia is 22.3% in Han, 18.2% in Tibetan, 11.8% in Qiang, 34.7% in Yi and 26.7% in Hui. Compared to Han, after adjusting sex and age, Qiang has a lower prevalence of sarcopenia (odds ratio [OR]: 0.44, 95% CI 0.35-0.55), Yi has a higher prevalence of sarcopenia (OR: 1.78, 95% CI 1.29-2.43). While adding adjusting other potential cofounders, sarcopenia is still less prevalent in Qiang (OR: 0.44, 95% CI 0.34-0.57).

CONCLUSIONS

The crude prevalence of sarcopenia is 22.3% in Han, 18.2% in Tibetan, 11.8% in Qiang, 34.7% in Yi and 26.7% in Hui. Sarcopenia was less prevalent in Qiang compared with Han. Further studies to determine related factors of sarcopenia among different ethnic groups are recommended.

Prevalence and Risk Factors Governing the Loss of Muscle Function in Elderly Sarcopenia Patients: A longitudinal Study in China with 4 Years of Follow-Up

OBJECTIVES

Data regarding the occurrence of risk factors that promote the loss of muscle mass, strength and function in sarcopenia patients in elderly Chinese patients are sparse. Here, we investigated the alterations in muscle mass, function and strength in those with sarcopenia over a 4-year period. We further evaluated the risk factors leading to a loss of grip strength, gait speed and skeletal muscle mass index in sarcopenia patients.

DESIGN

A face-to-face cross-sectional survey.

SETTING AND PARTICIPANTS

The study population consisted of 560 Chinese aged over 59 years.

MEASUREMENTS

Study recordings took places over a four-year period from 2014. Muscle mass was assessed through bioelectrical impedance analysis (BIA) performed on an Inbody720, Biospace. Hand-grip strength and 6 m walking speed were used as measurements of muscle strength and function. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria (AWGS).

RESULTS

In total, 474 of the elderly residents completed the follow-up. The rates of decreased ASMI, grip strength, and gait speed in the sarcopenia patients increased over the 4-year period. Following multivariate analysis, age was identified as the main risk factor for all the observed decrease, gender was specifically related to the loss of ASMI, stroke was a risk factor for gait speed and sarcopenia. A high BMI was a risk factor for a low gait speed but was protective for a loss of skeletal muscle mass and sarcopenia.

CONCLUSIONS

Age leads to a decline in muscle strength and function. In elderly Chinese patients with sarcopenia, the rates of reduced grip strength, gait-speed and sarcopenia increased. A high BMI was protective against the decline in muscle mass and sarcopenia, but represented a risk factor for low gait speed. Stoke was identified to cause a loss of gait speed in sarcopenia patients.

Association Between Number of Teeth, Denture Use and Frailty: Findings from the West China Health and Aging Trend Study

OBJECTIVE

Frailty and poor oral health are both common age-related conditions. However, the association between oral health and frailty has not been explored thoroughly among older Chinese adults. We aimed to investigate the associations between number of teeth, denture use, and frailty among older adults in western China.

DESIGN

Cross-sectional study.

SETTING

Community-based.

PARTICIPANTS

Participants were 4037 community-dwelling individuals aged 60 and older from the West China Health and Aging Trend (WCHAT) study.

MEASUREMENTS

Frailty was assessed using the physical frailty phenotype (PFP) and categorized as non-frail, prefrail and frail. In addition, number of teeth and denture use were examined by calibrated dentists. Multinomial logistic regression models were performed to examine the association between number of teeth, denture use, and frailty.

RESULTS

The overall prevalence of frailty was 6.7% among 4037 participants aged 60 and older in western China. Participants with no more than 20 teeth were associated with higher odds of being prefrail or frail whether wearing dentures or not. Denture using could not help lower the odds of being prefrail or frail for older adults with fewer teeth.

CONCLUSIONS

This study suggested that frailty was associated with having fewer teeth (≤20 teeth) among older Chinese adults. Future research involving targeted interventions addressing number of teeth may help provide information to establish effective strategies for frailty prevention in older adults.

Sarcopenia, Obesity and Sarcopenia Obesity in Comparison: Prevalence, Metabolic Profile, and Key Differences: Results from WCHAT Study

OBJECTIVE

To identify the prevalence, lifestyle factors, chronic disease status, and assessing the metabolic profile, comparing key differences in a cohort of subjects with non-sarcopenia/non-obesity (H), sarcopenia/non-obesity (S), non-sarcopenia/obesity (O) and sarcopenia obesity (SO) in a multi-ethnic population in west China.

DESIGN

A cross-sectional study.

SETTING

The communities in Yunnan, Guizhou, Sichuan, and Xinjiang provinces.

PARTICIPANTS

We included 4,500 participants aged 50 years or older who did bioelectrical impedance in our analysis from West China Health and Aging Trend (WCHAT) study.

MEASUREMENTS

We measured gait speed, handgrip strength and muscle mass by using bioelectrical impedance analysis (BIA) for all participants. We defined sarcopenia using the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia (AWGS). Obesity was defined as the highest sex-specific quintile of the percentage body fat. Different variables like anthropometry measures, life styles, chronic disease and blood test were collected. Analysis of variance and a multinomial logistic regression analysis adjusting for covariates were used to assess the differences of metabolic profiles among different groups.

RESULTS

Of 4500 participants aged 50 years old or older, the proportions of H, O, S, SO were 63.0%, 17.7%, 16.7% and 2.6%, respectively. And the prevalence of S subjects in men was 18.3% and 15.7% in women, while the prevalence of SO was 3.7% in men and 2.0% in women. Data showed that the prevalence of S and SO has an aging increase pattern which was opposite with O. Both S and SO tends to be older, lower educational level, without spouse, smoking, comorbidity of chronic disease, poor nutrition status, depression and cognitive decline compared to H and S seems to be worse than SO. Compared to H, S cohort showed a decrease in Vitamin D, triglyceride, albumin, fasting glucose, insulin, creatinine, ALT, nutrition scores and increase in HDL. SO cohort were observed for an increase in cholesterol, LDL, total protein and decrease in vitamin D. While O cohort showed an increase in triglyceride, cholesterol, LDL, total protein, glucose, insulin, WBC, uric acid, ALT and nutrition scores, but a decrease in HDL and vitamin D level.

CONCLUSIONS

Among individuals aged 50 years old or older in West China. S, O and SO participants demonstrate distinct differences in the life-styles, chronic disease profile, and metabolic profiles. The prevalence of S and SO has an aging increase pattern contrary to O. Both S and SO tend to be older, lower educational level, without spouse, smoking, comorbidity of chronic disease, poor nutrition status, depression and cognitive decline compared to H and S looks like to be worse than SO. Besides, the S subjects seem to have more metabolic index changes than SO compared to H. While O subjects have some contrary metabolic index to S subjects.

Prevalence and Its Associated Factors of Physical Frailty and Cognitive Impairment: Findings from the West China Health and Aging Trend Study (WCHAT)

OBJECTIVES

Previous literature has reported that physical frailty (PF) closely associated with cognitive impairment (CI). In this study, we aim to describe and evaluate the prevalence and associated factors with different patterns of PF and cognitive impairment.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

Community-dwelling older adults aged ≥60 from the West China Health and Aging Trend (WCHAT) study were included in this study.

MEASUREMENTS

Participants were assessed the PF and cognitive impairment. PF was assessed using the physical phenotype as defined by Fried's criteria. Cognitive impairment was identified using the Short Portable Mental Status Questionnaire (SPMSQ). According different patterns of PF and cognitive impairment, participants were divided into 4 groups: not-PF and cognitive intact ( "neither" group), not-PF and cognitive impairment ("CI only" group), PF and cognitive intact ("PF only" group), and PF and cognitive impairment ("both" group). Multinomial logistic regression was used to explore the association between medical conditions and different patterns of PF and cognitive impairment after adjusting the demographic characteristics.

RESULTS

Among 4,103 participants (age 67.8 + 5.9 years, female 58.3%), 78.8%, 3.9%, 14.5% and 2.9% were "neither", "PF only", "CI only", and "both", respectively. The prevalence of "PF only", "CI only" and "both" were associated with age, lower education level and single status. In addition, there was substantial ethnicity heterogeneity in the prevalence of different patterns of PF and cognitive impairment. Comparing with "neither", PF and/or cognitive impairment had higher association with depression, ADLs impairment, and malnutrition. Of note, obesity was only significantly associated with "PF only", but not associated with "CI only" or "both".

CONCLUSIONS

We found the substantial demographic and medical conditions disparities in different patterns of PF and cognitive impairment. Further research should focus on the efficient and practical screen to predict the risk of "PF only", "CI only" and "both".

The effectiveness of the "SMG" model for health-promoting lifestyles among empty nesters: a community intervention trial

Background

With the disintegration of the extended family in recent years, the empty-nest phenomenon is increasingly common in China and the health of empty nesters is attracting more attention. Lifestyles, accounting for 53% in determining death, play a vital role in improving the health of individuals. However, it was rarely studied in promoting the health of empty nesters. In this study, we proposed a “SMG” model in empty nesters, including the self-management, mutual management, and group management, to implement health-promoting lifestyles interventions among empty nesters to provide an effective means to improve their lifestyles and health.

Methods

We conducted a prospective intervention on 350 empty nesters in three communities located in Taiyuan, China. One hundred sixty-seven empty nesters were randomly assigned to the intervention group with SMG-based health-promoting lifestyles interventions used for 7-months, and 183 were randomly assigned to the control group with no measures imposed. The Health-Promoting Lifestyle Profile (HPLP-C) was used to rate the lifestyles of empty nesters. Generalized estimation model was used to analyze the differences between the intervention and control groups over time, adjusted for education and employment.

Results

After 7 months of health-promoting lifestyles intervention, HPLP-C score and each dimension score in the intervention group all increase from baseline. There were significant differences after intervention associated with time and group interaction effects in aspects of HPLP-C (mean score = 8.838, 95%CI:6.369–11.306), self-realization (mean score = 1.443, 95%CI:0.352–2.534), Health responsibility (mean score = 1.492, 95%CI:0.477–2.508), physical activity (mean score = 1.031, 95%CI:0.572–1.491), nutrition (mean = 0.827, 95%CI:0.177–1.476), interpersonal relations (mean = 2.917, 95%CI:2.365–3.469) and stress management (mean score = 0.729, 95%CI:0.131–1.327). And education is contributing to the effect of the health-promoting lifestyle intervention (Estimate:8.833, p < 0.001).

Conclusions

SMG-based health-promoting lifestyles intervention in empty nesters effectively improved the lifestyles of empty nesters, and the outcome was affected by education. Lifestyle change requires ongoing intervention, and community service centres must be involved in implementing the “SMG” model to provide ongoing support and improve the effect of interventions among empty nesters.

Trial registration

Chinese Clinical Trial ChiCTR1800015884. Registration date: 26–04-2018. Retrospectively registered.