Outcomes in the Year After First-Ever Ischemic Stroke in a Bi-Ethnic Population.

OBJECTIVE: To investigate stroke outcomes at 3, 6, and 12 months post-stroke overall and by ethnicity in a population-based, longitudinal study. METHODS: First-ever ischemic strokes (2014-2019, n = 1,332) among Mexican American persons (n = 807) and non-Hispanic white persons (n = 525) were identified from the Brain Attack Surveillance in Corpus Christi Project. Data were collected from patient or proxy interviews (baseline, 3, 6, and 12 months post-stroke) and medical records, including functional (activities of daily living/instrumental activities of daily living score), neurological (National Institutes of Health Stroke Scale), cognitive (Modified Mini-Mental State Examination), and quality of life (QOL) outcomes (12-domain Stroke-specific Quality of Life scale). Outcome trajectories were analyzed using multivariable adjusted linear models, with generalized estimating equations to account for within-subject correlations; interactions between ethnicity and time were included to investigate ethnic differences in outcomes. RESULTS: The median age was 67 years (interquartile range 58,78), 48.5% were women, and 60.6% were Mexican American persons. For all outcomes, significant improvement was seen between 3 and 6 months (p < 0.05 for all), with stability between 6 and 12 months. Mexican American persons had significantly worse outcomes compared with non-Hispanic white persons at all time points (3, 6, and 12 months), with the exception of the National Institutes of Health Stroke Scale, which did not differ by ethnicity at 6 and 12 months, and the average change in outcomes did not vary significantly by ethnicity. INTERPRETATION: Outcomes were at their worst at 3 months post-stroke, and ethnic disparities were already present, suggesting the need for early assessment and strategies to improve outcomes and possibly reduce disparities. ANN NEUROL 2023;93:348-356.

SDACS: Blockchain-Based Secure and Dynamic Access Control Scheme for Internet of Things.

With the rapid growth of the Internet of Things (IoT), massive terminal devices are connected to the network, generating a large amount of IoT data. The reliable sharing of IoT data is crucial for fields such as smart home and healthcare, as it promotes the intelligence of the IoT and provides faster problem solutions. Traditional data sharing schemes usually rely on a trusted centralized server to achieve each attempted access from users to data, which faces serious challenges of a single point of failure, low reliability, and an opaque access process in current IoT environments. To address these disadvantages, we propose a secure and dynamic access control scheme for the IoT, named SDACS, which enables data owners to achieve decentralized and fine-grained access control in an auditable and reliable way. For access control, attribute-based control (ABAC), Hyperledger Fabric, and interplanetary file system (IPFS) were used, with four kinds of access control contracts deployed on blockchain to coordinate and implement access policies. Additionally, a lightweight, certificateless authentication protocol was proposed to minimize the disclosure of identity information and ensure the double-layer protection of data through secure off-chain identity authentication and message transmission. The experimental and theoretical analysis demonstrated that our scheme can maintain high throughput while achieving high security and stability in IoT data security sharing scenarios.

Immune checkpoint molecule Tim-3 promotes NKT cell apoptosis and predicts poorer prognosis in Sepsis.

BACKGROUND: Sepsis is a leading cause of death among critically ill patients, which is defined as life-threatening organ dysfunction caused by a deregulated host immune response to infection. Immune checkpoint molecule Tim-3 plays important and complex roles in regulating immune responses and in inducing immune tolerance. Although immune checkpoint blockade would be expected as a promising therapeutic strategy for sepsis, but the underlying mechanism remain unknown, especially under clinical conditions. METHODS: Tim-3 expression and apoptosis in NKT cells were compared in septic patients (27 patients with sepsis and 28 patients with septic shock). Phenotypic and functional characterization of Tim-3+ NKT cells were analysed, and then the relationship between Tim-3 + NKT cells and clinical prognosis were investigated in septic patients. α-lactose (Tim-3/Galectin-9 signalling inhibitor) and Tim-3 mutant mice (targeting mutation of the Tim-3 cytoplasmic domain) were utilized to evaluate the protective effect of Tim-3 signalling blockade following septic challenge. RESULTS: There is a close correlation between Tim-3 expression and the functional status of NKT cells in septic patients, Upregulated Tim-3 expression promoted NKT cell activation and apoptosis during the early stage of sepsis, and it was associated with worse disease severity and poorer prognosis in septic patients. Blockade of the Tim-3/Galectin-9 signal axis using α-lactose inhibited in vitro apoptosis of NKT cells isolated from septic patients. Impaired activity of Tim-3 protected mice following septic challenge. CONCLUSIONS: Overall, these findings demonstrated that immune checkpoint molecule Tim-3 in NKT cells plays a critical role in the immunopathogenesis of septic patients. Blockade of immune checkpoint molecule Tim-3 may be a promising immunomodulatory strategy in future clinical practice for the management of sepsis.

Structural Engineering of Red Luminogens to Realize High Emission Efficiency through ACQ-to-AIE Transformation.

Deep red/near-infrared (NIR, >650 nm) emissive organic luminophores with aggregation-induced emission (AIE) behaviours have emerged as promising candidates for applications in optoelectronic devices and biological fields. However, the molecular design philosophy for AIE luminogens (AIEgens) with narrow band gaps are rarely explored. Herein, we rationally designed two red organic luminophores, FITPA and FIMPA, by considering the enlargement of transition dipole moment in the charge-transfer state and the transformation from aggregation-caused quenching (ACQ) to AIE. The transition dipole moments were effectively enhanced with a "V-shaped" molecular configuration. Meanwhile, the ACQ-to-AIE transformation from FITPA to FIMPA was induced by a methoxy-substitution strategy. The experimental and theoretical results demonstrated that the ACQ-to-AIE transformation originated from a crystallization-induced emission (CIE) effect because of additional weak interactions in the aggregate state introduced by methoxy groups. Owing to the enhanced transition dipole moment and AIE behaviour, FIMPA presented intense luminescence covering the red-to-NIR region, with a photoluminescence quantum yield (PLQY) of up to 38 % in solid state. The promising cell-imaging performance further verified the great potential of FIMPA in biological applications. These results provide a guideline for the development of red and NIR AIEgens through comprehensive consideration of both the effect of molecular structure and molecular interactions in aggregate states.

Neuroprotective Effects of Dammarane Sapogenins Against lipopolysaccharide-induced Cognitive Impairment, Neuroinflammation and Synaptic Dysfunction.

Neuroinflammation is a critical driver in the pathogenesis and progression of neurodegenerative disorders. Dammarane sapogenins (DS), a deglycosylated product of ginsenoside, possess a variety of potent biological activities. The present study aimed to explore the neuroprotective effects of DS in a rat model of neuroinflammation induced by intracerebroventricular injection of lipopolysaccharide (LPS). Our study revealed that DS pretreatment effectively improved LPS-induced associative learning and memory impairments in the active avoidance response test and spatial learning and memory in Morris water maze test. DS also remarkably inhibited LPS-induced neuroinflammation by suppressing microglia overactivation, pro-inflammatory cytok ine release (TNF-α and IL-1ß) and reducing neuronal loss in the CA1 and DG regions of the hippocampus. Importantly, pretreatment with DS reversed LPS-induced upregulation of HMGB1 and TLR4 and inhibited their downstream NF-κB signaling activation, as evidenced by increased IκBα and decreased p-NF-κB p65 levels. Furthermore, DS ameliorated LPS-induced synaptic dysfunction by decreasing MMP-9 and increasing NMDAR1 expression in the hippocampus. Taken together, this study suggests that DS could be a promising treatment for preventing cognitive impairments caused by neuroinflammation.

The effect of posterior cruciate ligament tibial avulsion fracture on functional outcomes in knees with concomitant ipsilateral lower limb fractures: a matched-cohort analysis.

BACKGROUND: At present, the optimal treatment for posterior cruciate ligament tibial avulsion fracture (PCLTAF) combined with concomitant ipsilateral lower limb fractures remains unclear. The present study aimed to assess the preliminary outcomes of treatment for PCLTAF with concomitant ipsilateral lower limb fractures by open reduction and internal fixation (ORIF). MATERIALS AND METHODS: The medical records of patients who sustained PCLTAF with concomitant ipsilateral lower limb fractures between March 2015 and February 2019 and underwent treatment at a single institution were retrospectively reviewed. Imaging examinations performed at the time of injury were applied to identify concomitant ipsilateral lower limb fractures. We used 1:2 matching between patients with PCLTAF combined with concomitant ipsilateral lower limb fractures (combined group; n = 11) and those with isolated PCLTAF (isolated group; n = 22). Outcome data were collected, including the range of motion (ROM) and visual analogue scale (VAS), Tegner, Lysholm, and International Knee Documentation Committee (IKDC) scores. At the final follow-up, the clinical outcomes were compared between the combined and isolated groups and between patients who underwent early-stage surgery and those who underwent delayed treatment for PCLTAF. RESULTS: Thirty-three patients (26 males, 7 females) were included in this study, with eleven patients having PCLTAF and concomitant ipsilateral lower limb fractures and a follow-up of 3.1 to 7.4 years (average, 4.8 years). Compared to patients in the isolated group, patients in the combined group demonstrated significantly worse Lysholm scores (85.7 ± 5.8 vs. 91.5 ± 3.9, p = 0.040), Tegner scores (4.4 ± 0.9 vs. 5.4 ± 0.8, p = 0.006), and IKDC scores (83.6 ± 9.3 vs. 90.5 ± 3.0, p = 0.008). Inferior outcomes were found in patients with delayed treatment. CONCLUSIONS: Inferior results were found in patients with concomitant ipsilateral lower limb fractures, while better outcomes were obtained in patients with PCLTAF through early-stage ORIF using the posteromedial approach. The present findings may help determine the prognoses of patients with PCLTAF combined with concomitant ipsilateral lower limb fractures treated through early-stage ORIF.

Cognitive recovery trajectories 3 months following stroke in Mexican American and non-Hispanic white adults.

OBJECTIVES: We examined whether cognitive trajectories from 0-3 months after stroke differ between Mexican Americans (MAs) and non-Hispanic white (NHW) adults. MATERIALS AND METHODS: The sample included 701 participants with ischemic stroke (62% MA; 38% NHW) from the population-based stroke surveillance study, the Brain Attack Surveillance in Corpus Christi (BASIC) Project, between 2008-2013. The outcome was the modified Mini Mental State Examination (3MSE, range 0-100 lower scores worse). Linear mixed effects models were utilized to examine the association between ethnicity and cognitive trajectories from 0-3 months following stroke, adjusting for confounders. RESULTS: MAs were younger, had lower educational attainment, and fewer had health insurance than NHWs (all p< 0.01). A smaller proportion of MAs were rated by informants as exhibiting pre-stroke cognitive decline than NHW (p < .0.05). After accounting for confounders, MAs demonstrated lower cognitive performance at post-stroke baseline and at 3-months following stroke (-2.00; 95% CI =-3.92, -0.07). Cognitive trajectories from 0-3 months following stroke were indicative of modest cognitive recovery (increase of 0.034/day, 95% CI =0.030-0.036) and did not differ between MAs and NHWs (p = 0.68). CONCLUSION: We found no evidence that cognitive trajectories in the first three months following stroke differed between MAs and NHWs. MAs demonstrated lower cognitive performance shortly after stroke and at three months following stroke compared to NHWs. Further research is needed to identify factors contributing to ethnic disparities in cognitive outcomes after stroke.

CdSe/ZnS QDs embedded polyethersulfone fluorescence composite membrane for sensitive detection of copper ions in various drinks.

The copper ion was detected rapidly by a novel sensing membrane in this paper for its damage to health and the environment. CdSe/ZnS QDs modified polyethersulfone membrane (QDs@PESM) was made by phase-inversion method using a membrane separation technique and quantum dots (QDs). When the sample passed through the membrane, the copper ions in the sample caused the membrane's fluorescence to be quenched. The fluorescence quenching value of the membrane is used to calculate the concentration of copper ions. With R2= 0.9964, Cu2+could be quantitatively detected over a wide concentration range (10-1000 µg/L). The method's LOD and LOQ were 4.27 and 14.23 µg/L, respectively. When the CdSe/ZnS QDs@PESM was used to analyze Cu2+ in various real drinks, including well water, baijiu, orange juice, beer, and milk, the recovery ranged from 79.1 to 123.9%, indicating that the CdSe/ZnS QDs@PESM can be used as a rapid, simple and reliable method to determine Cu2+ in various matrices.

Synchronous electrochemical detection of dopamine and uric acid by a PMo12@MIL-100(Fe)@PVP nanocomposite.

In this work, a noble-metal-free composite electrode was prepared based on PMo12O403- (PMo12), C9H5FeO7 (MIL-100(Fe), a Fe-based metal organic framework) and polyvinylpyrrolidone (PVP), and served as a high performance electrochemical sensor for synchronous detection of dopamine (DA) and uric acid (UA). The PMo12@MIL-100(Fe)@PVP composite electrode was fabricated by a in-situ hydrothermal method. Thanks to the synergistic effect of three active components (PMo12, MIL-100 and PVP), the electrode possesses large specific surface area and high electrical conductivity and therefore it shows high electrocatalytic oxidation performance of DA and UA with a spacing of 0.146 V between the two peak positions. These benefits of the electrode enable its electrochemical sensor to synchronously detect of DA and UA. Namely, the linear ranges can achieve 1-247 µM for DA and 5-406 µM for UA. Meanwhile, the detection limits are 0.586 µM for DA and 0.372 µM for UA. Moreover, the sensor can be applied to simultaneous determination of UA and DA in human serums with satisfactory recovery values.

Microbial and enzymatic battle with food contaminant zearalenone (ZEN).

Zearalenone (ZEN) contamination of various foods and feeds is an important global problem. In some animals and humans, ZEN causes significant health issues in addition to massive economic losses, annually. Therefore, removal or degradation of the ZEN in foods and feeds is required to be done. The conventional physical and chemical methods have some serious issues including poor efficiency, decrease in nutritional value, palatability of feed, and use of costly equipment. Research examined microbes from diverse media for their ability to degrade zearalenone and other toxins, and the findings of several investigations revealed that enzymes produced from microbes play a significant role in the degradation of mycotoxins. In established bacterial hosts, genetically engineered technique was used to enhance heterologously produced degrading enzymes. Then, the bio-degradation of ZEN by the use of micro-organisms or their enzymes is much more advantageous and is close to nature and ecofriendly. Furthermore, an effort is made to put forward the work done by different scientists on the biodegradation of ZEN by the use of fungi, yeast, bacteria, and/or their enzymes to degrade the ZEN to non-toxic products. KEY POINTS: •Evolved microbial strains degraded ZEA more quickly •Different degrading properties were studied.

Trends in Prevalence of Serious Psychological Distress and Depression Among Adults with Stroke in the United States.

OBJECTIVES: To examine national trends in prevalence of serious psychological distress and depression among adults with stroke in the United States (US) from 2004 to 2017, and variations across sociodemographic subgroups. METHODS: Data were obtained from the household components of the 2004-2017 Medical Expenditure Panel Survey, a nationally representative survey in the US. History of stroke or transient ischemic attack was based on self-report. Psychological distress was measured by the Kessler-6 scale, and depressive symptoms were measured by the 2-item Patient Health Questionnaire. Logistic regression models were used to examine the trends in prevalence of serious psychological distress and depression overall and by age, sex, and race/ethnicity. RESULTS: Among 10889 participants with stroke or transient ischemic attack, 60.0% were aged ≥ 65, 54.4% were female, and 72.2% were non-Hispanic white. The prevalence of serious psychological distress decreased from 14.9% in 2004-2005 to 11.3% in 2016-2017, corresponding to 7% lower odds every 2 years (adjusted odds ratio [aOR0.93, 95% confidence interval [CI]=0.89-0.97); and the prevalence of depression decreased from 23.1% in 2004-2005 to 18.3% in 2016-2017, corresponding to 5% lower odds every 2 years (aOR=0.95, 95% CI=0.92-0.98), after adjustment for sociodemographic characteristics, functional limitations, and antidepressant use. The trends varied significantly by age, but not sex and race/ethnicity. The overall decline was mainly driven by older adults above age 64. CONCLUSIONS: Prevalence of serious psychological distress and depression among US adults with stroke decreased from 2004 to 2017, but the burden of mental health problems remained high.

Racial and ethnic differences in sleep-disordered breathing and sleep duration among stroke patients.

OBJECTIVE: We sought to characterize racial and ethnic differences in pre- and post-stroke sleep-disordered breathing (SDB) and pre-stroke sleep duration. METHODS: Within the Brain Attack Surveillance in Corpus Christi cohort of patients with ischemic stroke (8/26/2010-1/31/2020), pre-stroke SDB risk was assessed retrospectively using the Berlin Questionnaire. Post-stroke SDB was defined by prospective collection of the respiratory event index (REI) using the ApneaLink Plus performed shortly after stroke. Pre-stroke sleep duration was self-reported. We used separate regression models to evaluate the association between race/ethnicity and each outcome (pre-stroke SDB, post-stroke SDB, and pre-stroke sleep duration), without and with adjustment for potential confounders. RESULTS: There was no difference in pre-stroke risk of SDB between Black and non-Hispanic white (NHW) participants (odds ratio (OR) 1.07, 95% CI 0.77-1.49), whereas MA (Mexican American), compared to NHW, participants had a higher risk of SDB before adjusting for demographic and clinical variables (OR 1.26, 95% CI 1.08-1.47). Post-stroke SDB risk was higher in MA (estimate 1.16, 95% CI 1.06-1.28) but lower in Black (estimate 0.79, 95% CI 0.65-0.96) compared to NHW participants; although, only the ethnic difference remained after adjustment. MA and Black participants had shorter sleep duration than NHW participants (OR 0.83, 95% CI 0.72-0.96 for MA; OR 0.67, 95% CI 0.49-0.91 for Black participants) before but not after adjustment. CONCLUSIONS: Racial/ethnic differences appear likely to exist in pre- and post-stroke SDB and pre-stroke sleep duration. Such differences might contribute to racial/ethnic disparities in stroke incidence and outcomes.

Novel 2D photocatalyst of copper-doped carbon quantum dot CD(Cu) loaded with ultrathin Ni-MOL for degradation of tetracycline.

Broadening the light absorption range and suppressing the carrier complexation are the two keys to enhance the photocatalytic activity. In this work, a novel two-dimensional (2D) photocatalyst was successfully prepared by modified hydrothermal method and applied in tetracycline (TC) degradation. The degradation rate of CD(Cu)-Ni-MOL for TC reached 93.5% within 60 min under the visible light condition. The improved photocatalytic performance of CD(Cu)-Ni-MOL was attributed to the constructed 2D layered structure and the special properties of CD(Cu). The doped Cu in carbon dots (CDs) exhibited excellent photocatalytic performance among the elements of Cu, Zn, Ni, Co and Fe. The order of photocatalytic performance improvement was Cu > Zn > Ni > Co > Fe. In addition, a possible degradation pathway for TC was proposed. This work confirms the great potential of CD(Cu)-Ni-MOL as a highly efficient photocatalyst in removing tetracycline pollutants in water.

Cactus-Inspired Janus Membrane with a Conical Array of Wettability Gradient for Efficient Fog Collection.

Fog collection plays an important role in alleviating the global water shortage. Despite great progress in creating bionic surfaces to collect fog, water droplets still could adhere to the microscale hydrophilic region and reach the thermodynamic stable state before falling, which delays the transport of water and hinders the continuous fog collection. Inspired by lotus leaves and cactuses, we designed a Janus membrane that functions to both collect fog from the air and transport it to a certain region. The Janus membrane with opposite wettability contains conical microcolumns with a wettability gradient and hydrophilic copper mesh surface. The apexes of conical microcolumns are superhydrophobic and the rest are hydrophobic. The fog droplets were deposited, coalesced, and directionally transported to the bottom of the conical microcolumns. Then, the droplets unidirectionally passed through the membrane and flowed into the water film on the surface of the copper mesh. The asymmetric structural and wettability merits endow the Janus membrane with an improved fog collection of ∼7.05 g/cm2/h. The study is valuable for designing and developing fluid control equipment in fog collection, liquid manipulation, and microfluidics.

Event-specific quantitative polymerase chain reaction methods for detection of double-herbicide-resistant genetically modified corn MON 87419 based on the 3'-junction of the insertion site.

MON 87419 was one of the new transgenic corn events developed in US with the trait of herbicide resistance to both dicamba and glyphosate. To monitor unintended release of genetically modified organism in the future, as well as to meet GM-labeling requirements, it is requisite to develop a reliable method for the detection and quantification of MON 87419, an event-specific primer pair was designed to amplify the 3'-junction site between the endogenous genome sequence and the transferred DNA of GM event MON 87419, amplicons of desired size were produced by qualitative polymerase chain reaction (PCR) assay. For the validation of this quantitative method, the mixed samples containing 10%, 1%, and 0.1% MON 87419 ingredient were quantified. The precisions were expressed as relative standard deviations, deviated by 7.87%, 12.94%, and 19.98%, respectively. These results clearly demonstrate that the PCR methods we developed herein can be used for event-specific quantitative testing of the double-herbicide-resistant corn MON 87419.

Isolation, Identification and Characterization of Paenibacillus pabuli E1 to Explore Its Aflatoxin B1 Degradation Potential.

Aflatoxin B1 (AFB1) contamination in feed and food seriously threatens the healthy growth of animals and humans, and it may lead to huge economic losses in livestock and poultry production. Therefore, screening of high-efficient AFB1-degrading bacteria is necessary to ensure the safety of feed and food. The study aims to isolate and characterize bacteria from various sources to explore its AFB1 degradation potential. Fifteen bacterial were obtained using a medium containing coumarin as the sole carbon source; only one strain showed a good-degrading ability in culture media by adding AFB1 and it was selected for further studies. A gram-negative and spore-forming, designated E1, was identified as Paenibacillus pabuli, with the highest sequence similarity to P. pabuli NBRC13638T (98.97%). The growth of the strain E1 was observed under 22-47 °C, pH 5.5-9.5 and NaCl concentration 0-6% (w/v), with optimum growth at 37 °C, pH 7.5 and 1% NaCl. The biodegradation characteristics of object strain were detected by high performance liquid chromatography (HPLC). The degradation ratio of AFB1 reached 55% at 24 h and 70.2% at 48 h. After 96 h, the degradation rate of AFB1 reached 85.9%. The active degradation components were present in the cell-free supernatant of strain E1, and the degradation ratio of AFB1 reached 80.0% after 96 h. It is the first report that genus Paenibacillus could degrade AFB1. Moreover, E1 has highly adaptable to diverse environmental conditions. It will be a potential candidate for biodegradation of mycotoxins in feed and food.

Accumulation risk and source apportionment of heavy metals in different types of farmland in a typical farming area of northern China.

The types of land used for farmland can greatly influence the source and accumulation risk of heavy metals in soil. However, the apportioning quantitatively the source of soil heavy metals has been studied insufficiently, especially in terms of different types of farmland. In this study, a total of 252 soil samples were taken from dry land, paddy fields and greenhouse fields in the Jinyuan district of Taiyuan city, China, to assess the accumulation risk of heavy metals (As, Cd, Cr, Cu, Hg, Ni, Pb and Zn). The results were then integrated, and source apportionment was evaluated by geospatial analysis, multivariate statistical analysis and positive matrix factorization (PMF). Cr, Cd and Hg were the dominant pollutants in the studied area. Accumulation risk by Cd and Cu was more severe in greenhouse fields than in dry land or paddy fields, whereas As, Hg and Pb had relatively higher accumulation in paddy fields than in dry land or greenhouse fields. Hg was derived mainly from coal combustion by atmospheric precipitation for the three types of farmland. Long-term irrigation using sewage is the main reason for the accumulation of Cu and Ni in dry land soil, Cu and Zn in paddy field soil and Zn in greenhouse soil. Cd in dry land, Cd and Pb in paddy fields and Cd, Cu, Ni and Pb in greenhouse fields were primarily added to soil through fertilization. Sewage irrigation and fertilization were the dominant sources of heavy metals for paddy field (31.3%) and greenhouse field (33.1%), respectively.

The Association of Comorbid Depression and Anxiety Symptoms With Disability Onset in Older Adults.

OBJECTIVE: Despite the high prevalence of late-life depression and anxiety at threshold and subthreshold levels, their joint role in the disablement process remains unclear. This study aims to examine the association of comorbid occurring depression and anxiety across the full spectrum of symptom severity with disability onset in older adults. METHODS: The study included 3663 participants from the 2011 National Health and Aging Trends Study, who reported no limitations in self-care and mobility activities at baseline. Disability onset was defined as a report of receiving help from another person in any of the activities for 3 consecutive months. Depression and anxiety symptoms were measured using the four-item Patient Health Questionnaire, grouped into low, mild, and moderate/severe symptom groups. Cox proportional hazards models were used to estimate relative risks for disability onset over a 5-year period by depression/anxiety symptom groups. RESULTS: A total of 1047 participants developed disability (24.6%; 6.0 per 1000 person-months). At baseline, one-fifth of the sample reported symptoms that were mild (n = 579 [14.9%]; 31.6% with disability onset) or moderate/severe (n = 156 [4.2%]; 38.1% with disability onset). After adjustment for sociodemographics, there was a dose-response relationship between depression/anxiety symptom groups and disability onset (mild versus low: hazard ratio [HR] = 1.43, 95% confidence interval [CI] = 1.20-1.70; moderate/severe versus low: HR = 1.94, 95% CI = 1.45-2.59). The increased risk remained significant after adjustment for health status variables for the mild symptom group (HR = 1.26, 95% CI = 1.07-1.49), but not for the moderate/severe symptom group (HR = 1.30, 95% CI = 0.94-1.79), possibly reflecting lower statistical power. CONCLUSIONS: Findings suggest that the full spectrum of depression and anxiety symptoms are associated with increased risk for disability in late life. Their role in the disablement process warrants further investigation.

Pulmonary contusion during the COVID-19 pandemic: challenges in diagnosis and treatment.

Managing patients with pulmonary contusion safely and effectively during the coronavirus disease 2019 (COVID-19) pandemic is challenging. This retrospective study analyzes the clinical data of 29 consecutive patients with pulmonary contusion, including two with COVID-19, at Tongji Hospital, Wuhan, China, in January and February, 2020. We analyzed the clinical manifestations, laboratory test results, computed tomography (CT) images, treatment, and clinical outcomes. The two patients with pulmonary contusion and COVID-19 had increased leukocyte and neutrophil counts, similar to the patients with pulmonary contusion alone. Interestingly, both these patients had subpleural ground glass opacity on CT images as a typical manifestation of COVID-19. All 29 patients were treated conservatively, including with closed thoracic drainage, instead of with thoracotomy. Six patients died of ARDS or craniocerebral injury, but the others stabilized. During the COVID-19 pandemic, patients with pulmonary contusion should be tested for SARS-CoV-2 and unless critical, thoracotomy should be avoided.

Beyond Depression: Estimating 12-Months Prevalence of Passive Suicidal Ideation in Mid- and Late-Life in the Health and Retirement Study.

OBJECTIVES: To provide valid estimates of the 12-month prevalence of passive suicidal ideation among older adults, without conditioning on depression status, using the Health and Retirement Study (HRS). METHODS: Data come from the 2012 HRS (n = 17,434) and 2004/5 Baltimore Epidemiologic Catchment Area (ECA) Study (n = 755). In the HRS, passive suicidal ideation (i.e., thought a lot about death-your own, someone else's, or death in general) is only assessed on respondents who reported dysphoria/anhedonia; in the ECA, ideation is assessed on all respondents, regardless of depression. We compare two approaches to estimating the 12-month prevalence of passive suicidal ideation in the HRS without conditioning on depression symptoms: 1) a probit selection model within the HRS, and 2) a prediction model developed using appended ECA data applied to the HRS. RESULTS: Using observed data alone on those who screened positive for depression, 6% of older adults reported passive suicidal ideation in the past year. Depending on the approach used, between 5.4% and 9.2% of HRS respondents who screened negative for depression would have reported passive suicidal ideation had they been assessed. Correcting for this selection bias, between 10.9% and 13.4% of U.S. adults over age 50 experienced passive suicidal ideation in 2012. CONCLUSIONS: Population surveillance of suicidal ideation among older adults is biased by survey approaches that only assess ideation in the context of depression.