Comorbidities in Patients With End-Stage Knee OA: Prevalence and Effect on Physical Function.

OBJECTIVE: To investigate the prevalence of comorbidities and their effect on physical function, quality of life (QOL), and pain, in patients with end-stage knee osteoarthritis (OA). DESIGN: A cross-sectional study. SETTING: A rehabilitation facility at university hospital. PARTICIPANTS: Patients (N=577; 503 women and 74 men) diagnosed with end-stage knee OA between October 2013 and June 2018. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Comorbidities were as follows: osteoporosis, presarcopenia, degenerative spine disease, diabetes, and hypertension. All patients completed the following performance-based physical function tests: stair-climbing test (SCT), 6-minute walk test (6MWT), timed Up and Go (TUG) test, and gait analysis. Self-reported physical function and pain were measured using Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and a visual analog scale (VAS), respectively, and self-reported QOL was measured using EuroQoL 5 dimensions (EQ-5D) questionnaire. RESULTS: Univariate analyses revealed that patients with osteoporosis had significantly higher scores in SCT ascent, SCT descent, TUG, WOMAC pain tests, and lower scores in 6MWT, gait speed, and cadence tests than those without osteoporosis. Patients with presarcopenia recorded higher scores in SCT ascent, TUG, EQ-5D, and lower scores in 6MWT and gait speed tests than those without presarcopenia. Patients with degenerative spine disease showed higher scores in WOMAC pain and lower scores in gait speeds than those without degenerative spine disease. Patients with diabetes showed higher scores in SCT ascent than those without diabetes, and patients with hypertension showed lower scores in 6MWT than those without hypertension. After adjusting age, sex, and body mass index, SCT descent retained significant association with osteoporosis, SCT ascent showed independent association with presarcopenia and diabetes, and WOMAC pain revealed significant association with degenerative spine disease. CONCLUSION: The results confirm associations between comorbidities, performance-based and self-reported physical functions, and QOL in patients with end-stage knee OA.

LuxR homologue SmcR is essential for Vibrio vulnificus pathogenesis and biofilm detachment, and its expression is induced by host cells.

Quorum sensing is a cell-to-cell communication system known to control many bacterial processes. In the present study, the functions of quorum sensing in the pathogenesis of Vibrio vulnificus, a food-borne pathogen, were assessed by evaluating the virulence of a mutant deficient in SmcR, a quorum-sensing regulator and homologue of LuxR. When biofilms were used as an inoculum, the smcR mutant was impaired in virulence and colonization capacity in the infection of mice. The lack of SmcR also resulted in decreased histopathological damage in mouse jejunum tissue. These results indicated that SmcR is essential for V. vulnificus pathogenesis. Moreover, the smcR mutant exhibited significantly reduced biofilm detachment. Upon exposure to INT-407 host cells, the wild type, but not the smcR mutant, revealed accelerated biofilm detachment. The INT-407 cells increased smcR expression by activating the expression of LuxS, an autoinducer-2 synthase, indicating that host cells manipulate the cellular level of SmcR through the quorum-sensing signaling of V. vulnificus. A whole-genome microarray analysis revealed that the genes primarily involved in biofilm detachment and formation are up- and downregulated by SmcR, respectively. Among the SmcR-regulated genes, vvpE encoding an elastolytic protease was the most upregulated, and the purified VvpE appeared to dissolve established biofilms directly in a concentration-dependent manner in vitro. These results suggest that the host cell-induced SmcR enhances the detachment of V. vulnificus biofilms entering the host intestine and thereby may promote the dispersal of the pathogen to new colonization loci, which is crucial for pathogenesis.

Vibrio vulnificus AphB is involved in interleukin-8 production via an NF-κB-dependent pathway in human intestinal epithelial cells.

We previously reported that the aphB gene mutant of Vibrio vulnificus had significantly impaired motility and adherence to host cells. In this study, we investigated the role of V. vulnificus AphB on the production of interleukin-8 (IL-8), a proinflammatory cytokine, as well as its underlying mechanism in human intestinal epithelial INT-407 cells. The aphB gene mutation significantly reduced the ability of V. vulnificus to stimulate IL-8 production and IL-8 gene promoter activation in INT-407 cells. The V. vulnificusaphB mutant also induced lower levels of NF-κB DNA binding activity and NF-κB minimal promoter activation than did the wild-type of V. vulnificus. Importantly, the observed reductions in IL-8 production, IL-8 gene promoter activation and NF-κB DNA binding activity were significantly restored by complementing the aphB gene into the V. vulnificusaphB mutant. These results indicate that V. vulnificus AphB is involved in the IL-8 production via an NF-κB dependent pathway in human intestinal epithelial cells.

Inductive Effect of Lewis Acidic Dopants on the Band Levels of Perovskite for a Photocatalytic Reaction.

Band-edge modulation of halide perovskites as photoabsorbers plays significant roles in the application of photovoltaic and photochemical systems. Here, Lewis acidity of dopants (M) as the new descriptor of engineering the band-edge position of the perovskite is investigated in the gradiently doped perovskite along the core-to-surface (CsPbBr3-CsPb1-xMxBr3). Reducing M-bromide bond strength with an increase in hardness of acidic M increases the electron ability of basic Br, thus strengthening the Pb-Br orbital coupling in M-Pb-Br, noted as the inductive effect of dopants. Especially, the highly hard Lewis acidic Mg localized in the outer position of the perovskite induces the increase of work function and then shifts band edge upward along the core-to-surface of the perovskite. Thus, charge separation driven by the dopant-induced internal electric field induces the slow annihilation of the excited holes, improving the slow aromatic Csp3-H dissociation in the photocatalytic oxidation process by ∼211% (491.39 µmol g-1 h-1) enhancements, compared with undoped nanocrystals.

Usefulness of Relative Handgrip Strength as a Simple Indicator of Cardiovascular Risk in Middle-Aged Koreans.

BACKGROUND: Reduced muscular strength, measured by handgrip strength, has been associated with increased risk for cardiovascular disease (CVD) and mortality. However, the prognostic significance of handgrip strength has been less well-studied in the middle-aged Korean population. This study determined whether handgrip strength predicted 10-year CVD risk in this population and whether there is a sex-specific difference. METHODS: The data were derived from the 2015 Korean National Health and Nutrition Examination Survey that included total of 2776 participants aged 40-69 years without prior history of CVD (men: 1184; women: 1592). Isometric relative handgrip strength was calculated by dividing absolute handgrip strength by body mass index. Participants were classified into three groups by their 10-year Framingham cardiovascular risk score: low (<10%), intermediate (10-19%), and high (≥20%). RESULTS: In men, relative handgrip strength was higher in the absence of hypertension, dyslipidemia, and diabetes compared with in the presence of these CVD risk factors. In women, a higher relative handgrip strength was observed in the absence of hypertension and dyslipidemia but not in the absence of diabetes compared with their counterparts. Advanced age was inversely associated with relative handgrip strength for both sexes. Multivariate logistic regression analysis demonstrated that an increased relative handgrip strength was a significant and independent predictor of low 10-year CVD risk among middle-aged women (odds ratio range 0.09-0.49, p < 0.001), but not among men. CONCLUSIONS: Handgrip strength is a simple and effective screening tool for risk stratification for CVD in middle-aged Korean women.

Oxide Passivation of Halide Perovskite Resistive Memory Device: A Strategy for Overcoming Endurance Problem.

Owing to a low operation voltage, high on/off ratio, and tunable band gap, halide perovskites (HPs) are being conceived as an alternative to oxide or chalcogenide materials in resistive-switching (RS) memory devices. However, the HP-based RS memory devices face problems such as short endurance, low retention, and device stability. Herein, the oxide-passivated HP devices were fabricated by hybridizing the oxide sol-gel and halide adduct methods. The silicon oxide (SiO2)-passivation enhanced the device properties with an endurance of 6000 cycles and retention of 1.8 × 104 s. The study of activation energy using ionic conductivity and time-of-flight secondary-ion mass spectroscopy demonstrated that the migration path of the Ag ions is well-controlled by the SiO2 passivation layer. Various oxides were used as passivation materials. Especially, the zirconium oxide-passivated devices exhibit excellent properties with an endurance of 57 000 cycles and retention of 7.8 × 104 s. The high cohesive energy of oxides effectively increased the formation voltage by retarding the Ag-ion migration, leading to the improved endurance properties of the devices. This paper proposes a strategy for significantly improving the low endurance property of HP-based RS memory devices using the oxide passivation technology.

Influence of Comorbidities on Short-Term Functional Outcomes After Unilateral Total Knee Arthroplasty.

OBJECTIVE: The aim of the study was to determine the effect of comorbidities on physical function and quality of life of patients at 3 mos after total knee arthroplasty. DESIGN: Data from 140 patients who underwent a primary unilateral total knee arthroplasty were examined retrospectively. Comorbidities were osteoporosis, presarcopenia, degenerative spine disease, diabetes, and hypertension. All patients completed the following: range of motion, stair climbing test, 6-min walk test, Timed Up and Go Test, peak torque of the knee extensor and flexor, instrumental gait analysis, Western Ontario McMaster Universities Osteoarthritis Index, and EuroQoL five-dimension questionnaire. RESULTS: Univariate analyses revealed that osteoporosis led to a significantly longer time to complete the stair climbing test-ascent, stair climbing test-descent, and Timed Up and Go Test and to lower scores for the 6-min walk test and peak torque of the knee extensor. Patients with degenerative spine disease showed significant negative scores for knee extension range of motion. Diabetes showed a negative correlation with peak torque of the knee extensor and knee flexion range of motion, as well as a higher Western Ontario McMaster Universities Osteoarthritis Index-stiffness score. Multivariable linear regression analysis showed that Western Ontario McMaster Universities Osteoarthritis Index-stiffness remained independently associated with diabetes. Six-minute walk test, Timed Up and Go Test, stair climbing test-ascent, and peak torque of the knee extensors showed a significant association with osteoporosis. CONCLUSIONS: Comorbidities, particularly osteoporosis and diabetes, affect short-term functional outcomes 3 mos after total knee arthroplasty.

Physical Performance Correlates with Self-Reported Physical Function and Quality of Life in Patients at 3 Months after Total Knee Arthroplasty.

BACKGROUND: Although total knee arthroplasty (TKA) is an effective treatment for knee osteoarthritis, assessment of postoperative outcomes remains unclear. This study aimed to identify postoperative physical performance factors that are correlated with self-reported physical function and quality of life (QoL) at 3 months after unilateral TKA. METHODS: In total, 158 patients who underwent unilateral primary TKA completed performance-based physical function tests at 3 months after surgery, including Stair Climbing Tests (SCT), 6-Minute Walk Tests (6MWT), Timed Up and Go tests (TUG), and instrumental gait analysis. We also measured the isometric knee flexor and extensor strengths of the operated and non-operated knees. Self-reported physical function and QoL were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Euro-QoL Five Dimensions (EQ-5D) questionnaire, respectively. RESULTS: Bivariate analyses showed that WOMAC function and EQ-5D were correlated with age, other self-reported measures, and performance-based measures. The WOMAC pain (r=0.71, p<0.001) showed a high positive correlation. While the EQ-5D (r=-0.7, p<0.001) showed a highly negative correlation with WOMAC function, WOMAC pain (r=-0.67, p<0.001) showed a moderately negative correlation with EQ-5D. In multivariate linear regression analyses, WOMAC pain, peak torque of the flexor of the non-operated knee, and reductions in extensor and stride length were associated with self-reported physical function, whereas WOMAC pain, SCT ascent, and cadence were associated with postoperative QoL. CONCLUSIONS: Physical performance factors were significantly associated with self-reported physical function and QoL in patients at 3 months after unilateral TKA. These findings suggest that performance-based physical function could be used to assess outcomes after TKA.

Measurement of Quantum Yields of Monolayer TMDs Using Dye-Dispersed PMMA Thin Films.

In general, the quantum yields (QYs) of monolayer transition metal dichalcogenides (1L-TMDs) are low, typically less than 1% in their pristine state, significantly limiting their photonic applications. Many methods have been reported to increase the QYs of 1L-TMDs; however, the technical difficulties involved in the reliable estimation of these QYs have prevented the general assessment of these methods. Herein, we demonstrate the estimation of the QYs of 1L-TMDs using a poly methyl methacrylate (PMMA) thin film embedded with rhodamine 6G (R6G) as a reference specimen for measuring the QYs of 1L-TMDs. The PMMA/R6G composite films with thicknesses of 80 and 300 nm demonstrated spatially homogeneous emissions with the incorporation of well-dispersed R6G molecules, and may, therefore, be used as ideal reference specimens for the QY measurement of 1L-TMDs. Using our reference specimens, for which the QY ranged from 5.4% to 22.2% depending on the film thickness and R6G concentrations, we measured the QYs of the exfoliated or chemical vapor deposition (CVD)-grown 1L-WS2, -MoSe2, -MoS2, and -WSe2 TMDs. The convenient procedure proposed in this study for preparing the thin reference films and the simple protocol for the QY estimation of 1L-TMDs may enable accurate comparisons of the absolute QYs between the 1L-TMD samples, thereby enabling the development of a method to improve the QY of 1L-TMDs.

Highly Efficient Photo-Induced Charge Separation Enabled by Metal-Chalcogenide Interfaces in Quantum-Dot/Metal-Oxide Hybrid Phototransistors.

Quantum dot (QD)-based optoelectronics have received great interest for versatile applications because of their excellent photosensitivity, facile solution processability, and the wide range of band gap tunability. In addition, QD-based hybrid devices, which are combined with various high-mobility semiconductors, have been actively researched to enhance the optoelectronic characteristics and maximize the zero-dimensional structural advantages, such as tunable band gap and high light absorption. However, the difficulty of highly efficient charge transfer between QDs and the semiconductors and the lack of systematic analysis for the interfaces have impeded the fidelity of this platform, resulting in complex device architectures and unsatisfactory device performance. Here, we report ultrahigh detective phototransistors with highly efficient photo-induced charge separation using a Sn2S64--capped CdSe QD/amorphous oxide semiconductor (AOS) hybrid structure. The photo-induced electron transfer characteristics at the interface of the two materials were comprehensively investigated with an array of electrochemical and spectroscopic analyses. In particular, photocurrent imaging microscopy revealed that interface engineering in QD/AOS with chelating chalcometallate ligands causes efficient charge transfer, resulting in photovoltaic-dominated responses over the whole channel area. On the other hand, monodentate ligand-incorporated QD/AOS-based devices typically exhibit limited charge transfer with atomic vibration, showing photo-thermoelectric-dominated responses in the drain electrode area.

Tailored 2D/3D Halide Perovskite Heterointerface for Substantially Enhanced Endurance in Conducting Bridge Resistive Switching Memory.

Hybrid organic-inorganic halide perovskites (HPs) have garnered significant attention for use in resistive switching (RS) memory devices due to their low cost, low operation voltage, high on/off ratio, and excellent mechanical properties. However, the HP-based RS memory devices continue to face several challenges owing to the short endurance and stability of the HP film. Herein, two-dimensional/three-dimensional (2D/3D) perovskite heterojunction films were prepared via a low-temperature all-solution process and their RS behavior was investigated for the first time. The 2D/3D perovskite RS devices exhibited excellent performance with an endurance of 2700 cycles, a high on/off ratio of 106, and an operation speed of 640 µs. The calculated thermally assisted ion hopping activation energy and the results of the time-of-flight secondary ion mass spectroscopy demonstrated that the 2D perovskite layer could efficiently prevent the Ag ion migration into the 3D perovskite film. Moreover, we found that owing to its high thermal conductivity, the 2D perovskite can control the rupture of the Ag conductive filament. Thus, the 2D perovskite layer enhances endurance by controlling both Ag migration and filament rupture. Hence, this study provides an alternate strategy for improving endurance of HP-based RS memory devices.

Mass spectrometry-based serum proteomic signature as a potential biomarker for survival in patients with non-small cell lung cancer receiving immunotherapy.

BACKGROUND: VeriStrat test is a serum assay which uses a mass spectrometry (MS)-based proteomic signature derived from machine learning. It is currently used as a prognostic marker for patients with non-small cell lung cancer (NSCLC) receiving chemotherapy. However, little is known about its role for NSCLC patients receiving immune checkpoint inhibitors (ICIs). METHODS: This is a retrospective study that includes 47 patients with advanced stage NSCLC without an activating EGFR mutation, who underwent the VeriStrat test from 2016 to 2018. Spectra from blood samples were evaluated to assign patients into the VeriStrat 'Good' (VS-G) or VeriStrat 'Poor' (VS-P) risk group. The clinical outcomes of 32 patients who received programmed cell death 1 (PD-1) inhibitors nivolumab or pembrolizumab were analyzed by VeriStrat status. RESULTS: The VS-G group demonstrated significantly higher progression-free survival (PFS) and overall survival (OS) compared to the VS-P group among overall NSCLC patients regardless of treatment (median PFS of 7.1 vs. 4.2 months, P=0.013, and median OS, not reached vs. 17.2 months, P=0.012). Among NSCLC patients treated with ICIs, VS-G classification was associated with significantly increased PFS in comparison to VS-P classification (median PFS of 6.2 vs. 3.0 months, P=0.012), while the differences in OS trended towards significance (median OS, not reached vs. 16.5 months P=0.076). Multivariate analysis showed that the VeriStrat status was significantly correlated with PFS and OS in NSCLC patients treated with ICIs (P=0.017, P=0.034, respectively). CONCLUSIONS: MS-based serum proteomic signature has potential as a biomarker for survival outcome in NSCLC patients receiving immunotherapy.

Rehabilitation of neuromyelitis optica: Two CARE-compliant case reports.

RATIONALE: Neuromyelitis optica (NMO), also known as Devic syndrome, is a central nervous system demyelinating disease consisting of optic neuritis and myelitis. Several studies have reported the effects of rehabilitation programs and specific exercises on outcomes in individuals with multiple sclerosis, but few have considered individuals with NMO. We present 2 cases of paraplegia due to NMO with rehabilitation outcome. PATIENT CONCERNS: The first case corresponds to a 65-year-old woman with NMO presented with C4 incomplete American Spinal Injury Association (ASIA) scale D, and the second case is a 41-year-old woman with NMO presented with C1 incomplete ASIA-C. DIAGNOSES: Two cases were confirmed by positive anti-aquaporin-4 antibody and presence of T2-weighted hyperintense lesion in spinal cord on magnetic resonance imaging. INTERVENTION: The first patient planned for focusing on left hand fine motor training through occupational therapy by strengthening and stretching muscle using E-link (Biometrics Ltd, Newport, UK) during 4 weeks, and the second patient received strengthening lower extremity and gait training using a lower-body positive pressure treadmill (AlterG, Anti-Gravity Treadmill, Fremont, CA) during 4 weeks. OUTCOMES: After a 4-week rehabilitation, the first patient's manual muscle testing was improved to grade 2/5 to 3+/5 in left upper limb specifically. Also, Spinal Cord Independence Measure (SCIM) was improved 79 to 88. Functional gains were made in bathing, upper-extremity dressing, and using chopsticks independently. Also, the second patient's manual muscle testing improved to grades 1 to 2/5 to 3 to 4/5 generally, and ASIA scale improved C5 incomplete ASIA-D. SCIM was improved to by allowing walking independently and increasing lower-extremity dressing and toileting ability. LESSONS: An intensive, multidisciplinary rehabilitation program may lead to neurological and functional gains in patients with NMO.

Bilateral Quadriceps Muscle Strength and Pain Correlate With Gait Speed and Gait Endurance Early After Unilateral Total Knee Arthroplasty: A Cross-sectional Study.

OBJECTIVE: The aim of this study was to determine the correlations between objective performance-based physical function, self-reported physical function, quality of life, and gait function at 1 mo after unilateral total knee arthroplasty. DESIGN: Cross-sectional data from 195 patients who underwent unilateral primary total knee arthroplasty were analyzed. The isometric knee extensor and flexor strength of both knees, gait parameters, 6-min walk test, timed up-and-go test, timed stair-climbing test, knee flexion and extension range of motion of surgical knee, Western Ontario McMaster Universities Osteoarthritis Index pain, stiffness, and functional levels, EuroQol five-dimensions questionnaire, and visual analog scale for knee pain were assessed. RESULTS: In bivariate analyses, both postoperative gait speed and gait endurance had significant positive correlations with postoperative peak torque of the extensor and flexor of both knees, cadence, stride length, and significant negative correlation with timed up-and-go, stair-climbing test ascent, stair-climbing test descent, visual analog scale, Western Ontario McMaster Universities Osteoarthritis Index pain, stiffness, and function levels. In the linear regression analyses, postoperative peak torque of the extensors of both knees and VAS for knee pain were factors correlated with postoperative gait speed and gait endurance. CONCLUSIONS: Quadriceps muscle strength of both knees and knee pain were important factors correlated with gait function early after total knee arthroplasty.

Functional Outcomes After Critical Pathway for Inpatient Rehabilitation of Total Knee Arthroplasty.

OBJECTIVE: To investigate functional outcomes after the application of a critical pathway for inpatient rehabilitation of total knee arthroplasty (TKA). METHODS: A total of 184 patients (57 males and 127 females; average age, 71.5±5.9 years) who underwent unilateral or bilateral TKA were included. The critical pathway included early, intensive individualized rehabilitation exercises. Patients completed the following performance-based physical function tests: the stair climbing test (SCT), 6-minute walk test (6MWT), and Timed Up and Go test (TUG) as well as measurement of isometric knee flexor and extensor strength of the operated knee, gait speed, and range of knee flexion and extension. Self-reported physical function and pain were measured using the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS), respectively, and self-reported quality of life was measured using the EuroQoL 5 dimension (EQ-5D) questionnaire. These evaluations were performed preoperatively and at 1 month and 3 months postoperatively. RESULTS: Performance-based and self-reported physical function and quality of life measures improved nonlinearly over time. Specifically, the 6WMT, TUG, gait speed, WOMAC-pain, WOMAC-function, VAS, and EQ-5D scores showed a significant improvement at 1-month post-TKA, whereas SCT, peak torque of the knee extensors and flexors, and WOMAC-stiffness scores showed gradual, but substantial, improvements over 3 months. There were between-group differences (unilateral and bilateral TKA groups) in the time course of the SCT, 6MWT, TUG, VAS, WOAMC-stiffness, and WOMAC-function results. CONCLUSION: Patients who underwent critical pathway rehabilitation after TKA showed significant improvements in functional measurements during the first 3 months post-surgery.

Antisolvent with an Ultrawide Processing Window for the One-Step Fabrication of Efficient and Large-Area Perovskite Solar Cells.

Photovoltaic technologies based on perovskite absorber materials have led this optoelectronic field into a brand-new horizon. However, the present antisolvents used in the one-step spin-coating method always encounter problems with the very narrow process window. Herein, anisole is introduced into the one-step spin-coating method, and the technology is developed to fabricate perovskite thin films with ultrawide processing window with a dimethylformamide (DMF):dimethyl sulfoxide (DMSO) ratio varying from 6:4 to 9:1 in the precursor solution, anisole dripping time ranging from 5 to 25 s, and an antisolvent volume varying from 0.1 to 0.9 mL. Perovskite thin films as large as 100 cm2 are successfully fabricated using this method. Maximum photoelectric conversion efficiencies of 19.76% for small-area (0.14 cm2 ) and 17.39% for large-area (1.08 cm2 ) perovskite solar cell devices are obtained. It is also found that there are intermolecular hydrogen-bonding forces between anisole and DMF/DMSO that play critical roles in the wide process window. These results provide a deeper understanding of the crystallizing procedure of perovskite during the one-step spin-coating process.