Defining an international cut-off of two-legged countermovement jump power for sarcopenia and dysmobility syndrome.

We aimed to establish jump power cut-offs for the composite outcome of either sarcopenia (EWGSOP2) or dysmobility syndrome using Asian and Caucasian cohorts. Estimated cut-offs were sex specific (women: < 19.0 W/kg; men: < 23.8 W/kg) but not ethnicity specific. Jump power has potential to be used in definitions of poor musculoskeletal health. PURPOSE: Weight-corrected jump power measured during a countermovement jump may be a useful tool to identify individuals with poor musculoskeletal health, but no cut-off values exist. We aimed to establish jump power cut-offs for detecting individuals with either sarcopenia or dysmobility syndrome. METHODS: Age- and sex-matched community-dwelling older adults from two cohorts (University of Wisconsin-Madison [UW], Korean Urban Rural Elderly cohort [KURE], 1:2) were analyzed. Jump power cut-offs for the composite outcome of either sarcopenia defined by EWGSOP2 or dysmobility syndrome were determined. RESULTS: The UW (n = 95) and KURE (n = 190) cohorts were similar in age (mean 75 years) and sex distribution (68% women). Jump power was similar between KURE and UW women (19.7 vs. 18.6 W/kg, p = 0.096) and slightly higher in KURE than UW in men (26.9 vs. 24.8 W/kg, p = 0.050). In UW and KURE, the prevalence of sarcopenia (7.4% in both), dysmobility syndrome (31.6% and 27.9%), or composite of either sarcopenia or dysmobility syndrome (32.6% and 28.4%) were comparable. Low jump power cut-offs for the composite outcome differed by sex but not by ethnicity (< 19.0 W/kg in women; < 23.8 W/kg in men). Low jump power was associated with elevated odds of sarcopenia (adjusted odds ratio [aOR] 4.07), dysmobility syndrome (aOR 4.32), or the composite of sarcopenia or dysmobility syndrome (aOR 4.67, p < 0.01 for all) independent of age, sex, height, and ethnicity. CONCLUSION: Sex-specific jump power cut-offs were found to detect the presence of either sarcopenia or dysmobility syndrome in older adults independent of Asian or Caucasian ethnicity.

The diagnostic value of phase angle, an integrative bioelectrical marker, for identifying individuals with dysmobility syndrome: the Korean Urban-Rural Elderly study.

Low phase angle, a non-invasive bioimpedance marker, is associated with elevated odds of dysmobility syndrome and its components. Phase angle (estimated cutoffs: < 4.8° in men; < 4.5° in women) can be used to detect dysmobility syndrome in community-dwelling older adults as a simple, integrative screening tool. INTRODUCTION: Dysmobility syndrome uses a score-based approach to predict fracture risk that incorporates the concepts of osteoporosis, sarcopenia, and obesity. Low phase angle (PhA), a simple, non-invasive bioelectrical impedance marker, was associated with low lean mass, high fat mass, and poor muscle function. We aimed to investigate the association between PhA and dysmobility syndrome, with the exploration of the diagnostic cutoffs. METHODS: In a community-dwelling Korean older adult cohort, dysmobility syndrome was defined as the presence of ≥ 3 of the following components: osteoporosis, low lean mass, falls in the preceding year, low grip strength, high fat mass, and poor timed up and go performance. RESULTS: Among the 1825 participants (mean age 71.6, women 66.7%), subjects were classified into sex-stratified PhA tertiles. The prevalence of dysmobility syndrome increased from the highest PhA tertile group to the lowest (15.50 to 2.45% in men; 33.41 to 12.25% in women, P for trend < 0.001). The mean PhA values decreased as the dysmobility score increased (5.33° to 4.65° in men; 4.76° to 4.39° in women, P for trend < 0.001). Low PhA (cutoff: < 4.8° in men; < 4.5° in women) was associated with twofold elevated odds of dysmobility syndrome after adjusting for age, sex, and conventional risk factors. Low PhA improved the identification of individuals with dysmobility syndrome when added to the conventional risk model (area under the curve, 0.73 to 0.75, P = 0.002). CONCLUSION: Low PhA was associated with dysmobility syndrome and its components, independent of age, sex, body mass index, nutritional status, and inflammation.

Effects of clarithromycin on the pharmacokinetics of evogliptin in healthy volunteers.

WHAT IS KNOWN AND OBJECTIVE: Evogliptin (DA-1229), a novel dipeptidyl peptidase (DPP)-4 inhibitor with high potency and selectivity, was approved in Korea for the treatment of type 2 diabetes. Preclinical studies suggest that it is metabolized by cytochrome (CYP) P450 isozymes. Based on these findings, a clinical study was designed to investigate the pharmacokinetic (PK) interaction of evogliptin with a CYP inhibitor, clarithromycin. METHODS: An open-label, two-phase, crossover study was conducted with 12 healthy subjects. On day 1, a single dose of evogliptin 5 mg was administered alone to assess the reference PK profile of evogliptin. On day 10, after a 2-day pretreatment with clarithromycin, evogliptin 5 mg was administered again to evaluate the effect of CYP inhibition on the PK profile of evogliptin. Administration of clarithromycin continued until day 14. Blood sampling in the reference and test phases was performed until 96 and 168 hours after dosing, respectively for PK assays. RESULTS: Eleven of the 12 subjects completed the study, and their data were analysed. In the presence of clarithromycin, exposure to evogliptin increased without any serious adverse events and the geometric mean peak plasma concentration (Cmax ) and area under the concentration-time curve from time 0 extrapolated to infinity (AUC0-∞ ) of evogliptin increased by 116.5% and 89.6%, respectively. WHAT IS NEW AND CONCLUSION: Administration of clarithromycin significantly increased exposure to evogliptin in healthy subjects.

Self-assembled growth and luminescence of crystalline Si/SiOx core-shell nanowires.

Crystalline Si/SiOx core/shell nanowires (NWs) are self-assembled by annealing Ni-coated hydrogenated Si-rich SiOx (SRO:H) films at 1100 degrees C in the presence of Si powder. Plasma-enhanced chemical vapor deposition is used to grow 100 nm SRO:H thin films with varying silicon concentration (n(Si)). The NWs vary from SiOx nanowires to Si/SiOx core/shell structures depending on the composition of the SRO:H substrate, with the fraction of core/shell structures increasing with increasing Si concentration. As n(Si) increases from 37 to 43 at.%, the average diameter of the NWs also increases from 48 to 157 nm. A growth model based on the diffusion-assisted vapor-liquid-solid mechanism is proposed to explain how the core/shell structures are self-assembled. Photoluminescence (PL) spectra of the individual NWs have two major emission bands in the near UV (381 nm) and blue (423 nm) ranges at n(Si) = 43 at.%, named as UV and BL PL bands, respectively. In contrast, only the BL PL band is observed at n(Si) < or = 39 at.%. These results suggest that the BL and UV PL bands can be attributed to the defect states in the SiOx shell and at the Si core/SiOx shell interface, respectively, and that the BL band is closely related to the growth process of the NWs.

Effect of Na4O7P2 on Cu powder preparation from Cu2O-water slurry system.

A unique approach is presented for preparing highly dispersed ultrafine copper particles from cuprous oxide slurry using a wet chemical reaction with hydrazine (N2H4) as a reductant along with an appropriate addition of sodium pyrophosphate (Na4O7P2) as a surfactant. It was found that very thin oxidized surfaces on the copper particles are formed during the reaction in the solution and subsequently sodium pyrophosphate plays an important role in the zeta potential of the particles, affecting their dispersion and growth significantly. The copper particles at low zeta potential easily aggregate and grow to bigger ones, whereas they at high zeta potential keep away each other and grew individually to ultrafine size. Additionally, a model for the copper particles growth in accordance with dispersion is proposed.

Not all patients pursue prostate biopsy after abnormal prostate specific antigen results.

In prostate cancer, digital rectal examination (DRE) and serum prostate specific antigen (PSA) are used to evaluate the risk of prostate cancer. However, in published community-based screening samples, not all patients with abnormal test results pursue biopsy. To test the existence of and quantify diagnostic dropout in clinic-based early detection samples, we conducted a prospective patterns-of-care study designed to identify variables associated with pursuit of diagnostic steps. Of 76 patients with abnormal PSA and/or DRE, only 43 (57%) pursued prostate biopsy. Prostate specific antigen, but not age or chart-based comorbidities, was predictive of further diagnostic and therapeutic steps. Among patients with abnormal test results, age and abnormal PSA and DRE, but not chart-based comorbidities, strongly correlated with physician intention to diagnose prostate cancer. The factors that cause diagnostic dropout are unknown, but based on experience with other cancers, they may relate to psychological variables in tested patients. That pursuit of diagnosis and treatment appears to occur with no association with chart-based comorbidities is worrisome given the power of comorbidities to predict mortality in prostate cancer patients. Finally, from a public health perspective, a reproducible dropout phenomenon implies that the positive predictive value of DRE and PSA testing may be seriously underestimated.

Ureterocystoplasty with preservation of ipsilateral renal function.

Recently the ureter has been used for bladder augmentation in selected patients with abnormal bladders and dilated upper tracts. The ureter has several advantages over other forms of bladder augmentation because it alleviates electrolyte disturbances, mucous production, and the disruption of the gastrointestinal tract. Initial reports emphasized the use of the entire ureter and renal pelvis in patients with an ipsilateral dilated nonfunctioning renal unit. Herein the authors report five cases of ureterocystoplasties performed since July 1993, in which the ipsilateral renal unit was preserved. All patients underwent preoperative videourodynamic studies, which showed small-for-age bladder capacity and poor compliance. Three patients underwent unilateral ureterocystoplasty, and two had bilateral ureterocystoplasty. Transureteroureterostomy (TUU) was performed in all patients, and most of the ipsilateral dilated ureter was used for augmentation. In two patients who had partial unilateral duplication, ipsilateral upper-to-lower ureteropyelostomy was done in addition to the TUU to maximize the amount of ureter available for augmentation. The follow-up period ranges from 6 to 24 months. All patients are continent and free of vesicoureteral reflux. All show stabilization or improvement of their upper tracts. Pressure-specific bladder capacity (bladder capacity at 30 cm of water pressure) increased by 350% (from a mean of 142 mL to 500 mL). The ureter is an excellent choice for augmentation cystoplasty in selected patients. An ipsilateral functioning renal unit is not a contraindication for ureterocystoplasty.

Ureterocystoplasty.

Augmentation cystoplasty is the treatment of choice for the hyperreflexic, poorly compliant bladder unresponsive to medical treatment. While the etiology for such bladders is multiple, the clinical manifestations are few and include urinary incontinence, urinary tract infections, and upper tract deterioration. When such bladders are accompanied by hydroureteronephrosis with or without reflux, the dilated ureter and pelvis may be used to augment the bladder. Ureterocystoplasty is rapidly gaining acceptance among pediatric urologic surgeons. Dilated ureter is clearly the best tissue available for augmentation. It is lined with transitional cell epithelium, and the muscular backing provides the necessary properties for a compliant reservoir. The lack of mucous production and absorptive or secretory properties of urothelium prevents some of the most common problems encountered with other forms of augmentation cystoplasty (e.g., metabolic abnormalities, mucous production, lithiasis, and recurrent infections). The use of urothelium also eliminates the long-term concern of malignant degeneration of bowel used in augmentation.

Predicting the Efficacy of Protein-Energy Supplementation in Frail Older Adults Living in Community.

BACKGROUND: Protein-energy malnutrition is a major cause of functional decline in the elderly and is clearly an important component of frailty. However, limited evidence is available about how to select frail individuals most benefiting from protein-energy supplementation. OBJECTIVES: 1) To investigate factors associated with stronger benefits from protein-energy supplementation, and 2) to test the hypothesis that the severity of frailty is associated with the efficacy of protein-energy supplementation. DESIGN: Secondary analysis of data from a pre-post-intervention study and a clinical trial. SETTING: National Home Healthcare Services in Gangbuk-gu, Seoul, South Korea. PARTICIPANTS: 123 community-dwelling frail older adults [usual gait speed (UGS) <0.6m/sec and Mini Nutritional Assessment (MNA) <24]. INTERVENTION: Each participant was received with two 200 mL per day of commercial liquid formula (providing additional 400 kcal of energy and 25 g of protein per day) for 12 weeks. MEASUREMENTS: Relative change in the Physical Functioning (PF) and Short Physical Performance Battery (SPPB) score between the baseline and 12-week follow-up assessments were measured. RESULTS: Multilevel mixed-effect linear regression analysis showed that a lower level of baseline UGS was associated with a greater improvement in PF and SPPB score after adjustment for age, gender, education, living status, beneficiary of public assistance, number of chronic diseases, compliance, and type of dataset (p<0.001). A lower level of baseline MNA score was associated with greater change in PF and SPPB score after adjustment for multiple covariates (p≤0.045). Participants with severe frailty (UGS <0.3 m/sec + MNA <17) showed 52.4% and 44.6% more relevant improvements in PF and SPPB score, respectively, than those with mild frailty (UGS 0.3-0.6 m/sec + MNA 17-24) (p<0.001). CONCLUSION: Slower UGS and lower MNA score are independently associated with the greater efficacy of protein-energy supplementation on functional status.

Mortality risk factors of Acinetobacter baumannii bacteraemia.

BACKGROUND: Acinetobacter baumannii is one of the most important nosocomial pathogens, and its multiple antibiotic resistance has emerged as an obstacle in the treatment of these infections worldwide. AIMS: To identify risk factors of mortality for A. baumannii bacteraemia. METHODS: A retrospective cohort study of 72 patients with significant A. baumannii bacteraemia was conducted to evaluate risk factors for mortality. RESULTS: The median age of the 72 enrolled patients was 48 years, 96% of the cases were hospital-acquired, and the bacteraemia-related mortality rate was 29% (21 of 72 patients). Univariate analysis revealed that the risk factors for mortality included: an elevated acute physiology and chronic health evaluation (APACHE II) score, receipt of in vitro ineffective definitive antimicrobial therapy, in vitro A. baumannii resistance to cefoperazone/ sulbactam, neutropenia, and presentation with septic shock. Multivariate analysis reveals that the independent risk factors for mortality are neutropenia and elevated APACHE II scores. CONCLUSION: Risk factors such as neutropenia and elevated APACHE II scores are found to be associated with higher mortality rates of A. baumannii bacteraemia. Further study is necessary for the determination of optimal strategies for both the prevention and treatment of these infections.

Simultaneous ureterocystoplasty and living related renal transplantation.

Enterocystoplasty in preparation for renal transplantation in children with severely dysfunctional bladders is widely accepted by pediatric urologists and transplant surgeons alike. The risk for septic and other complications in this immunosuppressed population remains elevated however, since problems inherent to the use of bowel or stomach in the urinary tract become magnified in these patients. In addition, simultaneous enterocystoplasty and transplantation carry a significant risk, and we must therefore subject these children to two major operations within a short time span. We herein describe our experience with combining simultaneously ureterocystoplasty and renal transplantation in a child. We believe this procedure has major relevance, in particular in the group of patients with posterior urethral valves and chronic renal failure.

Indications of neutrino oscillation in a 250 km long-baseline experiment.

The K2K experiment observes indications of neutrino oscillation: a reduction of nu(mu) flux together with a distortion of the energy spectrum. Fifty-six beam neutrino events are observed in Super-Kamiokande (SK), 250 km from the neutrino production point, with an expectation of 80.1(+6.2)(-5.4). Twenty-nine one ring mu-like events are used to reconstruct the neutrino energy spectrum, which is better matched to the expected spectrum with neutrino oscillation than without. The probability that the observed flux at SK is explained by statistical fluctuation without neutrino oscillation is less than 1%.

Search for electron neutrino appearance in a 250 km long-baseline experiment.

We present a search for electron neutrino appearance from accelerator-produced muon neutrinos in the K2K long-baseline neutrino experiment. One candidate event is found in the data corresponding to an exposure of 4.8 x 10(19) protons on target. The expected background in the absence of neutrino oscillations is estimated to be 2.4+/-0.6 events and is dominated by misidentification of events from neutral current pi(0) production. We exclude the nu(micro) to nu(e) oscillations at 90% C.L. for the effective mixing angle in the 2-flavor approximation of sin((2)2theta(microe)( approximately 1/2sin((2)2theta(13))>0.15 at Deltam(2)(microe)=2.8 x 10(-3) eV(2), the best-fit value of the nu(micro) disappearance analysis in K2K. The most stringent limit of sin((2)2theta(microe)<0.09 is obtained at Deltam(2)(microe)=6 x 10(-3) eV(2).

Observation of a (6)(LambdaLambda)He double hypernucleus.

A double-hyperfragment event has been found in a hybrid-emulsion experiment. It is identified uniquely as the sequential decay of ( 6)(LambdaLambda)He emitted from a Xi(-) hyperon nuclear capture at rest. The mass of ( 6)(LambdaLambda)He and the Lambda-Lambda interaction energy DeltaB(LambdaLambda) have been measured for the first time devoid of the ambiguities due to the possibilities of excited states. The value of DeltaB(LambdaLambda) is 1.01+/-0.20(+0.18)(-0.11) MeV. This demonstrates that the Lambda-Lambda interaction is weakly attractive.