Beyond Bites: Differential Role of Fall Armyworm Oral Secretions and Saliva in Modulating Sorghum Defenses.

Flavonoids are major plant secondary metabolites that provide defense against several insect pests. Previously, it has been shown that sorghum (Sorghum bicolor) flavonoids are required for providing resistance to fall armyworm (FAW; Spodoptera frugiperda), which is an important chewing insect pest on several crops. We demonstrate here the role of FAW oral cues in modulating sorghum flavonoid defenses. While feeding, chewing insects release two kinds of oral cues: oral secretions (OS)/regurgitant and saliva. Our results indicate that FAW OS induced the expression of genes related to flavonoid biosynthesis and total flavonoids, thereby enhancing sorghum's defense against FAW larvae. Conversely, FAW saliva suppressed the flavonoid-based defenses and promoted FAW caterpillar growth, independent of the FAW salivary component, glucose oxidase (GOX). Thus, we infer that different oral cues in FAW may have contrasting roles in altering sorghum defenses. These findings expand our understanding of the precise modes of action of caterpillar oral cues in modulating plant defenses and help in designing novel pest management strategies against FAW in this vital cereal crop. [Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.

Adaptive evolution of invasive fall armyworms to maize with potential involvement of Cytochrome P450 genes.

BACKGROUND: An invasion occurs when introduced species establish and maintain stable populations in areas outside of their native habitat. Adaptive evolution has been proposed to contribute to this process. The fall armyworm (Spodoptera frugiperda) is one of the major pest insects infesting maize in both invaded and native areas. The invasion of this species was reported from West Africa in 2016, followed by spreading across the Old World. We tested adaptive evolution to maize using 56 native samples from the USA and 59 invasive samples from Senegal, based on genomic and transcriptomic analyses. RESULTS: Principal component analysis revealed that the Senegalese population originated from corn strain. Three genetic loci were identified as targets of selective sweeps in the Senegalese population. These loci include four Cytochrome P450 genes (CYP321B1, CYP321B3, CYP321B4, and CYP337B5), as well as 12 genes of which the function is unclear. Transcriptomic analysis showed an overexpression of CYP321B1 and CYP321B3 genes in sfC samples compared to sfR samples. Additionally, these two genes were overexpressed when corn strain samples were exposed to maize. In larval feeding assays, the Senegalese population exhibited higher survival rates than a Floridan population across all four tested maize varieties. CONCLUSIONS: These results suggest that the analyzed Senegalese population experienced adaptive evolution involving loci containing CYP genes, potentially associated with an increase in the survival rates on maize. We argue that the invasive success of the fall armyworm is contributed by stabilizing selection to maize.

Automated Identification of Fall-related Injuries in Unstructured Clinical Notes.

Fall-related injuries (FRIs) are a major cause of hospitalizations among older patients, but identifying them in unstructured clinical notes poses challenges for large-scale research. In this study, we developed and evaluated Natural Language Processing (NLP) models to address this issue. We utilized all available clinical notes from the Mass General Brigham for 2,100 older adults, identifying 154,949 paragraphs of interest through automatic scanning for FRI-related keywords. Two clinical experts directly labeled 5,000 paragraphs to generate benchmark-standard labels, while 3,689 validated patterns were annotated, indirectly labeling 93,157 paragraphs as validated-standard labels. Five NLP models, including vanilla BERT, RoBERTa, Clinical-BERT, Distil-BERT, and SVM, were trained using 2,000 benchmark paragraphs and all validated paragraphs. BERT-based models were trained in three stages: Masked Language Modeling, General Boolean Question Answering (QA), and QA for FRI. For validation, 500 benchmark paragraphs were used, and the remaining 2,500 for testing. Performance metrics (precision, recall, F1 scores, Area Under ROC [AUROC] or Precision-Recall [AUPR] curves) were employed by comparison, with RoBERTa showing the best performance. Precision was 0.90 [0.88-0.91], recall [0.90-0.93], F1 score 0.90 [0.89-0.92], AUROC and AUPR curves of 0.96 [0.95-0.97]. These NLP models accurately identify FRIs from unstructured clinical notes, potentially enhancing clinical notes-based research efficiency.

Stomata: gatekeepers of uptake and defense signaling by green leaf volatiles in maize.

Plants adapt to balance growth-defense tradeoffs in response to both biotic and abiotic stresses. Green leaf volatiles (GLVs) are released after biotic and abiotic stresses and function as damage-associated signals in plants. Although, GLVs enter plants primarily through stomata, the role of stomatal regulation on the kinetics of GLV uptake remains largely unknown. Here, we illustrate the effect of stomatal closure on the timing and magnitude of GLV uptake. We closed stomata by either exposing maize (Zea mays) plants to darkness or applying abscisic acid, a phytohormone that closes the stomata in light. Then, we exposed maize seedlings to (Z)-3-hexen-1-ol and compared its dynamic uptake under different stomatal conditions. Additionally, we used (E)-3-hexen-1-ol, an isomer of (Z)-3-hexen-1-ol not made by maize, to exclude the role of internal GLVs in our assays. We demonstrate that closed stomata effectively prevent GLV entry into exposed plants, even at high concentrations. Furthermore, our findings indicate that reduced GLV uptake impairs GLV-driven induction of biosynthesis of sesquiterpenes, a group of GLV-inducible secondary metabolites, with or without herbivory. These results elucidate how stomata regulate the perception of GLV signals, thereby dramatically changing the plant responses to herbivory, particularly under water stress or dark conditions.

Investigating the relationship between sagittal spinal curvature and fall incidence and fall risk among elderly nursing home residents.

Designing appropriate diagnostic and treatment methods to reduce fall risk and improve quality of life, as well as reduce the cost of care in elderlies. Our findings have potential for early diagnosis of those with a high probability of falling based on fairly simple clinical measures of hyperkyphosis, forward head, and lordosis. INTRODUCTION: Poor balance is an underlying cause of falling in the elderly, for which a change in the natural curvature of the spine plays a major role. Little is known about the relationship between spinal curvatures and fall incidence in this population. We primarily aimed to investigate the relationship between sagittal plane spinal curvatures and fall incidence over 1 year among nursing facility residents. Secondarily, we aim to determine associations of sagittal plane spinal curvatures with participants' perception of fall risk and balance capability. METHODS: Participants (100 residents mean age 70.17 ± 6.01 years) underwent standing measures of sagittal plane spinal curvatures (flexible ruler technique) and forward displacement of the head relative to the cervical spine. The Tinetti Performance Oriented Mobility Assessment (POMA) and Fall Efficacy Scale assessed participants' perception of balance and fear of falling. Incident falls were self-reported monthly and tracked across 1 year. Spearman's correlations and logistic regression evaluated associations between fall incidence and spinal curvature. Predictive performance of spinal curvature and fall risk was determined by the corresponding ROC for defining a cut-off for variables of spinal curvature and fall risk indicators. RESULTS: Predictive performance of spinal curvature and fall risk factors indicated 84% and 77% of participants were correctly classified using models of kyphosis and head angle, respectively. CONCLUSIONS: Our study adds new data on spinal curvatures and incident falls among nursing facility residents. Efforts are needed to intervene to counter progression of spinal curvatures and improve fall prevention practices.

Global burden of hip fracture: The Global Burden of Disease Study.

This study is the first to measure global burden of hip fracture in patients aged 55 years and older across 204 countries and territories from 1990 to 2019. Our study further proved that the global burden of hip fracture is still large. Hip fractures among males are perhaps underestimated, and older adults should be given more attention. PURPOSE: Hip fracture is a tremendous universal public health challenge, but no updated comprehensive and comparable assessment of hip fracture incidence and burden exists for most of the world in older adults. METHODS: Using data from the Global Burden of Diseases (GBD) 2019, we estimated the number and rates of the incidence, prevalence, and years lived with disability (YLD) of hip fracture across 204 countries and territories in patients aged 55 years and older from 1990 to 2019. RESULTS: In 2019, the incidence, prevalence, and YLDs rates of hip fracture in patients aged 55 years and older were 681.35 (95% UI 508.36-892.27) per 100000 population, 1191.39 (95% UI 1083.80-1301.52) per 100000 population, and 130.78 (95% UI 92.26-175.30) per 100000 population. During the three decades, the incidence among people aged below 60 years showed a downward trend, whereas it showed a rapid upward trend among older adults. All the numbers and rates of hip fractures among females were higher than those among males and increased with age, with the highest number and rate in the highest age group. Notably, the male to female ratio of the incidence for people aged over 55 years increased from 0.577 in 1990 to 0.612 in 2019. Falls were the leading cause among both sexes and in all age groups. CONCLUSIONS: The incidence and the number of hip fractures among patients aged 55 years and older increased over the past three decades, indicating that the global burden of hip fracture is still large. Hip fractures among males are perhaps underestimated, and older adults should be given more attention.

Clinical features of fallers and non-fallers: finding best-performing combinations of physical performance measurements to discriminate physical impairments between fallers and non-fallers among older adults with and without osteoporosis.

Is osteoporosis related to worst outcomes after fall accidents? After a fall accident, there were no differences in walking and balance between individuals with/without osteoporosis. Gains in fat tissue, higher pain, and difficulty to walk were related to previous falls, regardless of osteoporosis. PURPOSE: Impairments are expected after an accidental fall in the older age; whoever, it is still unclear if patients suffering from osteoporosis are in higher risks of fall accidents and if such accidents would cause worst outcomes compared with older adults without osteoporosis. The objective of this study was to discriminate fallers and non-fallers via a combination of physical performance measurements of older adults (65 + years) with and without osteoporosis. METHODS: Older adults (n = 116) were screened for a previous fall accident and tested during (i) quiet stance; (ii) single- and dual-task walking; (iii) 8-Foot Up-and-Go; (iv) Mini BESTest; (v) 2-min step-in-place and (vi) 30-s chair stand. Evaluation of average daily pain intensity and total body fat% were obtained. RESULTS: Forty-four subjects (38%) reported a previous fall accident. There was, however, no association between osteoporosis and previous fall. Fallers had a higher daily pain intensity, higher body fat%, slower walking speed during a cognitive dual-task test and worse performance at the 8-Foot Up-and-Go test and the Mini BESTest compared to non-fallers. CONCLUSIONS: Although the presence of osteoporosis might not increase the risk of fall accidents, healthcare professionals should expect that accidental falls in older adults are associated with higher body fat%, higher daily pain intensity and problems performing daily activities such as walking.

Management of Osteoporosis, Fracture and Falls in People with Multiple Sclerosis: Systematic Review of Guidelines.

People with multiple sclerosis (MS) have a higher prevalence of osteoporosis, falls and fractures. Guidelines for MS populations targeting the management of osteoporosis, fracture and falls risk may help reduce the burden of musculoskeletal disease in this population. We aimed to systematically review current guidelines regarding osteoporosis prevention, screening, diagnosis and management in people with MS. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a systematic review of scientific databases (MEDLINE, CINAHL, Embase and Scopus) was performed (n = 208). In addition, websites from MS organisations and societies were screened for clinical guidelines (n = 28). Following duplicate removal, screening and exclusions (n = 230), in total six guidelines were included in this review. Three of the identified guidelines were specific to managing osteoporosis in MS, while two linked vitamin D to bone health and one was focused on the effect of acute glucocorticoid use for MS exacerbations on bone health. All guidelines were found to contain inadequate recommendations for osteoporosis screening, management and treatment in people with MS given the evidence of higher prevalence of osteoporosis at an earlier age and compounding risk factors in this population. Early diagnosis and treatment of osteoporosis in people with MS is necessary as fractures lead to significant morbidity and mortality. Development of structured clinical guidelines directed at specific healthcare services will ensure screening, appropriate management, and care of bone health in people with MS.

A custom-built step exergame training programme to prevent falls in people with multiple sclerosis: A multicentre randomised controlled trial.

BACKGROUND: Cognitive-motor step training can improve stepping, balance and mobility in people with multiple sclerosis (MS), but effectiveness in preventing falls has not been demonstrated. OBJECTIVES: This multisite randomised controlled trial aimed to determine whether 6 months of home-based step exergame training could reduce falls and improve associated risk factors compared with usual care in people with MS. METHODS: In total, 461 people with MS aged 22-81 years were randomly allocated to usual care (control) or unsupervised home-based step exergame training (120 minutes/week) for 6 months. The primary outcome was rate of falls over 6 months from randomisation. Secondary outcomes included physical, cognitive and psychosocial function at 6 months and falls over 12 months. RESULTS: Mean (standard deviation (SD)) weekly training duration was 70 (51) minutes over 6 months. Fall rates did not differ between intervention and control groups (incidence rates (95% confidence interval (CI)): 2.13 (1.57-2.69) versus 2.24 (1.35-3.13), respectively, incidence rate ratio: 0.96 (95% CI: 0.69-1.34, p = 0.816)). Intervention participants performed faster in tests of choice-stepping reaction time at 6 months. No serious training-related adverse events were reported. CONCLUSION: The step exergame training programme did not reduce falls among people with MS. However, it significantly improved choice-stepping reaction time which is critical to ambulate safely in daily life environment.

Curvilinear walking elevates fall risk and modulates slip and compensatory step attributes after unconstrained human slips.

While much attention has been paid to understanding slip-related falls in humans, little has been focused on curvilinear paths despite their prevalence, distinct biomechanical demands and increased slipping threat. We determined the mechanics, compensatory stepping reactions and fall risk associated with slips during fixed-speed walking across ranges of path curvature, slipped foot and slip onset phase contexts possible in the community, which builds upon previous work by examining speed-independent effects of curvilinear walking. Twenty-one participants experienced 15 unconstrained slips induced by a wearable friction-reducing device as motion capture and harness load cell data were recorded. Falls were most likely after early stance slips to the inside foot and increased at tighter curvatures. Slip distance and peak velocity decreased as slips began later in stance phase, did not differ between feet, and accelerated on tighter paths. Slipping foot directions relative to heading transitioned from anterior (forward) to posterior (backward) as slips began later in stance, were ipsilateral (toward the slipping foot side) and contralateral (toward the opposite side) for the outside and inside foot, respectively, and became increasingly ipsilateral/contralateral on tighter curvatures. Compensatory steps were placed anteriorly and ipsilaterally after outside and inside foot slips, respectively, and lengthened at later onset phases for outside foot slips only. Our findings illustrate slip magnitude and fall risk relationships that suggest slip direction may influence the balance threat posed by a slip, imply that walking speed may modify slip likelihood, and indicate the most destabilizing curved walking contexts to target in future perturbation-based balance training approaches.

Reaction time in psychomotor vigilance task is related to hypoxic load in males with sleep apnea.

Oxygen saturation (SpO2 )-based parameters are more strongly linked to impaired daytime vigilance than the conventional diagnostic metrics in patients with obstructive sleep apnea (OSA). However, whether the association between SpO2 -based parameters and impaired daytime vigilance is modulated by sex, remains unknown. Hence, we investigated the interplay between sex and detailed SpO2 -based metrics and their association with impaired vigilance in patients with OSA. The study population consisted of 855 (473 males, 382 females) patients with suspected OSA who underwent overnight polysomnography and psychomotor vigilance task (PVT). The population was grouped by sex and divided into quartiles (Q1-Q4) based on median reaction times (RTs) in the PVT. In addition to conventional diagnostic metrics, desaturation severity (DesSev), fall severity (FallSev), and recovery severity (RecovSev) were compared between the sexes and between the best (Q1) and worst (Q4) performing quartiles by using cumulative distribution functions (CDFs). Additionally, sex-specific covariate-adjusted linear regression models were used to investigate the connection between the parameters and RTs. The CDFs showed significantly higher hypoxic load in Q4 in males compared to females. In addition, the DesSev (ß = 8.05, p < 0.01), FallSev (ß = 6.48, p = 0.02), RecovSev (ß = 9.13, p < 0.01), and Oxygen Desaturation Index (ß = 12.29, p < 0.01) were associated with increased RTs only in males. Conversely, the Arousal Index (ß = 10.75-11.04, p < 0.01) was associated with impaired vigilance in females. The severity of intermittent hypoxaemia was strongly associated with longer RTs in males whereas the Arousal Index had the strongest association in females. Thus, the impact of hypoxic load on impaired vigilance seems to be stronger in males than females.

Blunt Cerebrovascular Injury Complications in Aging Adults: A National Trauma Database Study.

INTRODUCTION: Blunt cerebrovascular injury (BCVI) is defined as a nonpenetrating injury to the carotid or vertebral arteries which can be highly morbid. Because BCVI is rare, most studies have been devoted to triaging trauma patients for BCVI identification, with little data available regarding the complications these patients experience after initial evaluation. Here, we analyze the association of complications during admission for BCVI patients. METHODS: The National Trauma Databank was queried from 2007 to 2014 for adults ≥65 y old. Demographics, incidence of BCVI, and injury data were evaluated using univariate analysis. Rates of inpatient complications due to acutely acquired infections and strokes were evaluated using univariate and multivariable analysis. RESULTS: We identified 666,815 non-BCVI and 552 BCVI patients. Patients with a BCVI were typically male, White, younger (65-75-y-old), had three or more comorbidities, and had Medicare insurance. BCVI patients had a mild head injury upon arrival at the emergency department and experienced a motor vehicle accident/fall. The median length of stay in the intensive care unit, days spent on a ventilator, and presence of polytrauma were higher among BCVI patients. BCVI patients had increased odds of experiencing a stroke and pneumonia as complications while admitted compared to their non-BCVI counterparts. CONCLUSIONS: Postinjury, patients who suffered a BCVI had higher odds of stroke and pneumonia than patients who did not experience a BCVI. Additional studies are needed to determine the modifiable risk factors associated with BCVIs among aging adults.

Assessing Fall Mortality by Field-Relevant Categories at an Urban Level I Trauma Center.

INTRODUCTION: Little research has focused on assessing the mortality for fall height based on field-relevant categories like falls from greater than standing (FFGS), falls from standing (FFS), and falls from less than standing. METHODS: This retrospective observational study included patients evaluated for a fall incident at an urban Level I Trauma Center or included in Medical Examiner's log from January 1, 2015, to June 31, 2017. Descriptive statistics characterized the sample based on demographic variables such as age, race, sex, and insurance type, as well as injury characteristics like relative fall height, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), traumatic brain injury, intensive care unit length of stay, and mortality. Bivariate analysis included Chi-square tests for categorical variables and Student t-tests for continuous variables. Subsequent multiple logistic regression modeled significant variables from bivariate analyses, including age, race, insurance status, fall height, ISS, and GCS. RESULTS: When adjusting for sex, age, race, insurance, ISS, and GCS, adults ≥65 who FFS had 1.93 times the odds of mortality than those who FFGS. However, those <65 who FFGS had 3.12 times the odds of mortality than those who FFS. Additionally, commercial insurance was not protective across age groups. CONCLUSIONS: The mortality for FFS may be higher than FFGS under certain circumstances, particularly among those ≥65 y. Therefore, prehospital collection should include accurate assessment of fall height and surface (i.e., water, concrete). Lastly, commercial insurance was likely a proxy for industrial falls, accounting for the surprising lack of protection against mortality.

Utility of Torso Imaging for Elderly Patients Sustaining Ground-Level Falls.

INTRODUCTION: Computed tomography (CT) of the torso has become increasingly common for assessment of fall patients in the emergency department. Some data suggest that older adults (≥65) may benefit from torso imaging more than younger patients. We sought to evaluate the usage and utility of CT imaging for elderly patients presenting after ground-level falls (GLFs) from 1 meter or less at our level 1 trauma center. METHODS: Patients ≥18 presenting with GLF in 2015-2019 were included. Data were obtained through chart and trauma registry review. Descriptive statistics were used to summarize the use of CT imaging for patients younger than versus older than 65 y old. Three multivariate logistic regression models with age as a continuous, binary (<65 versus ≥65), or categorical (in multiples of 5) variable were used to investigate whether age is associated with an increased identification of traumatic injury not previously suspected or known based on physical exam (PE) or plain radiograph after GLF. RESULTS: A total of 522 patients <65 and 673 patients ≥65 y old were included. Older patients were significantly more likely to receive screening chest radiograph, screening pelvic radiograph, brain CT, and neck CT (all P < 0.001), but not torso (chest, abdomen, and pelvis) CT (P = 0.144). On multivariate logistic regression, age was not significantly associated with an increased odds of identification of traumatic injury after torso CT (continuous: adjusted odds ratio [aOR] = 1.01, 95% confidence interval [CI] = 0.99-1.03, P = 0.379; binary: aOR = 0.86, 95% CI = 0.46-1.58, P = 0.619; categorical: aOR = 1.03, 95% CI = 0.94-1.14, P = 0.453). A positive PE was the only variable associated with significantly increased odds of having an abnormal torso CT scan in all models. Only two patients ≥65 y old had injuries identified on torso CT in the context of a negative PE and negative screening imaging. CONCLUSIONS: The rate of torso injury identification in patients sustaining GLF is not associated with age, but is strongly associated with positive PE findings. In the subset of elderly GLF patients without positive torso PE findings, more conservative use of CT imaging could decrease health-care utilization costs without compromising patient care.

Community-science reveals delayed fall migration of waterfowl and spatiotemporal effects of a changing climate.

Climate change has well-documented, yet variable, influences on the annual movements of migratory birds. The effects of climate change on fall migration remains understudied compared with spring but appears to be less consistent among species, regions and years. Changes in the pattern and timing of waterfowl migration in particular may result in cascading effects on ecosystem function, and socio-economic and cultural outcomes. We investigated changes in the migration of 15 waterfowl species along a major flyway corridor of continental importance in northeastern North America using 43 years of community-science data. We built spatially- and temporally explicit hierarchical generative additive models for each species and demonstrated that climate, specifically the interaction between minimum temperature and precipitation, significantly influences migration phenology for most species. Certain species' migratory movements responded to specific temperature thresholds (climate migrants) and others reacted more to the interaction of temperature and precipitation (extreme event migrants). There are already significant changes in the fall migration phenology of common waterfowl species with high ecological and economic importance, which may simply increase in the context of a changing climate. If not addressed, climate change could induce mismatches in management, regulations and population surveys which would negatively impact the hunting industry. Our findings highlight the importance of considering species-specific spatiotemporal scales of effect on climate on migration and our methods can be widely adapted to quantify and forecast climate-driven changes in wildlife migration.

Les changements climatiques ont des influences bien documentées, mais variables, sur les mouvements annuels des oiseaux migrateurs. Les effets des changements climatiques sur les migrations automnales demeurent peu étudiés par rapport aux migrations printanières, mais il semble qu'ils soient moins constants d'une espèce, d'une région et d'une année à l'autre. Les changements dans le patron et le calendrier de la migration de la sauvagine en particulier peuvent avoir des effets en chaîne sur la fonction des écosystèmes et des impacts socio­économiques et culturels. Nous avons étudié les changements dans la migration de 15 espèces de sauvagine le long d'un corridor de migration d'importance continentale dans le nord­est de l'Amérique du Nord, en utilisant 43 ans de données scientifiques communautaires. Nous avons construit des modèles additifs généralisés hiérarchiques spatialement et temporellement explicites pour chaque espèce et avons démontré que le climat, en particulier l'interaction entre la température minimale et les précipitations, influence de manière significative la phénologie de la migration pour la plupart des espèces. Les mouvements migratoires de certaines espèces répondent à des seuils de température spécifiques (migrateurs climatiques) et d'autres réagissent davantage à l'interaction entre la température et les précipitations (migrateurs d'événements extrêmes). La phénologie des migrations automnales d'espèces de sauvagine commune qui ont une grande importance écologique et économique connaît déjà des changements importants, qui pourraient simplement s'accentuer dans le cadre des changements climatiques. S'ils ne sont pas pris en compte, les changements climatiques pourraient induire des décalages dans la gestion, les réglementations et les enquêtes de population, ce qui aurait un impact négatif sur l'industrie de la chasse. Nos résultats soulignent l'importance de prendre en compte les échelles spatio­temporelles spécifiques sur la migration et nos méthodes peuvent être largement adaptées pour quantifier et prévoir les changements induits par le climat dans la migration de la faune.

Efficacy and safety of romosozumab: a meta-analysis of placebo-controlled trials.

INTRODUCTION: We aimed to comprehensively compile placebo-controlled trials on the efficacy and safety of romosozumab (210 mg, subcutaneously, once monthly) in postmenopausal women and men with osteoporosis. MATERIALS AND METHODS: PubMed, Google Scholar, and ClinicalTrials.gov were searched for relevant placebo-controlled trials (as of January 1, 2024). Percent change in bone mineral density (BMD), falls, fractures, and adverse events (AEs) after drug administration were collected. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. RESULTS: Six trials (7990 patients; follow-up period, 6-12 months) were included. Compared with placebo, romosozumab significantly increased lumbar spine BMD (MD = 12.69; 95% CI 11.10-14.29), total hip BMD (MD = 4.42; 95% CI 3.03-5.80), and femoral neck BMD (MD = 3.99; 95% CI 2.42-5.57) at 12 months. Romosozumab significantly decreased falls (RR = 0.80; 95% CI 0.68-0.93) and major osteoporotic fractures (RR = 0.37; 95% CI 0.25-0.54), but increased injection-site reactions (RR = 1.83; 95% CI 1.46-2.30) within 12 months. No significant differences were observed in other AEs (including cardiovascular AEs) within 12 months. CONCLUSION: Romosozumab treatment resulted in a significant BMD gain, reduced falls and major osteoporotic fractures. It was generally well-tolerated, including the cardiovascular aspects. However, clinicians should consider the occurrence of minor AEs (e.g., injection-site reactions).

Alcohol and toxicological factors influencing fatal falls from height in the Greater Tokyo Area: a retrospective study.

Falls from height pose a significant public health concern in urban regions, including the highly urbanized Greater Tokyo Area. The Japanese population is characterized by high rates of suicide and psychoactive drug usage, underscoring the importance of investigating these attributes in falls from height. This study aimed to retrospectively analyze the alcohol and toxicological aspects influencing falls from height in the Greater Tokyo Area between 2014 and 2022 and compare the findings with existing reports on other populations. In total, 75 cases of falls from height and 159 cases of natural deaths were included. Consistent with previous findings, Fisher's exact test revealed a predominance of males (66.67%, 50/75) and young adults (57.33%, 43/75) in falls from height. Multivariate logistic regression analysis identified antidepressant usage as the most significant risk factor within the target population, while younger individuals under alcohol influence constituted another high-risk group. Notably, contradictory to other populations, female individuals involved in fatal falls in the Greater Tokyo Area exhibited a higher frequency of alcohol consumption than males (48.00%, 12/25 vs. 26.00%, 13/50), and most of them were associated with suicide (83.33%, 10/12). These findings elucidate the population characteristics that pose a high risk for fatal falls from height in Japan and can serve as a reference for other Asian populations residing in similar megacities.

Balance impairment and associated factors among stroke survivors in public hospitals of Amhara regional state: a multicenter cross-sectional study.

INTRODUCTION: Balance impairment is one of the common impairments in patients after stroke. It can lead to depression reduced speed of mobility, dependent on assistive device and reduce quality of life. However, evidence on balance impairment and its risk factors among stroke survivors in Ethiopia was lacking particularly in the study area. Therefore, this study aimed to investigate prevalence and associated factors of balance impairment among stroke survivor's attendee at an outpatient clinic in Amara regional state comprehensive specialized hospital. METHODS: An institutional based cross-sectional study was conducted from April1-June 30, 2022. A total of 400 participants were selected using the systematic random sampling technique. Standard Berg balance scale tool and semi-structure questionnaire was used. Multicollinearity and model fitness were checked. Variables with a p-value of less than 0.25 in the Bivariable regression were entered into a multivariable logistic regression and p value < 0.05 was used as cutoff point for significant variables. RESULT: The prevalence of balance impairment was 51.5% (95% CI (46.58, 56.39). Being depressed (AOR = 12.25:95% CI (4.727, 31.779), using walking aids (AOR = 8.76:95%CI3.469, 22.117)), abnormal speed (AOR = 6.73:95%CI (2.671, 16.977)), did not have physiotherapy treatment (AOR = 3.96:95%CI (1.483, 10.586), and unmarried (AOR = 2.71, 95% CI = 1.061, 6.903) were significantly associated with balance impairment. CONCLUSION AND RECOMMENDATION: The prevalence of balance impairment in the study was high. Being depressed, use walking aids, did not have physiotherapy treatment, abnormal speed of mobility, and unmarried were significantly associated factors. Therefore; it is better to give greater emphasis for those factors.

Different neurocognitive controls modulate obstacle avoidance through pregnancy.

Understanding why falls during pregnancy occur at over 25% rate over gestation has clinical impacts on the health of pregnant individuals. Attention, proprioception, and perception of the environment are required to prevent trips and falls. This research aimed to understand how the changes to these neurocognitive processes control obstacle avoidance through gestation. Seventeen pregnant participants were tested five times in 6-week intervals. Participants walked an obstacle course (OC), and we analyzed the crossings over obstacles that were set to 10% of participants' body height. Participants also performed an attentional network test (ANT: performance of specific components of attention), an obstacle perception task (OP: ability to visually define an obstacle and translate that to a body posture), and a joint position sense task (JPS: ability to recognize and recreate a joint position from somatosensation). In the OC task, average leading and trailing foot crossing heights significantly reduced by 13% and 23% respectively, with no change in variation, between weeks 13 and 31 of pregnancy, indicating an increased risk of obstacle contact during this time. The variability in minimum leading foot distances from the obstacle was correlated with all three neurocognition tasks (ANT, OP, and JPS). Increased fall rates in the second and third trimesters of pregnancy may be driven by changes in attention, with additional contributions of joint position sense and environmental perception at various stages of gestation. The results imply that a holistic examination on an individual basis may be required to determine individual trip risk and appropriate safety modifications.

Functional electrical stimulation to enhance reactive balance among people with hemiparetic stroke.

BACKGROUND: Individuals with stroke demonstrate a twofold higher fall incidence compared to healthy counterparts, potentially associated with deficits in reactive balance control, which is crucial for regaining balance from unpredictable perturbations to the body. Moreover, people with higher stroke-related motor impairment exhibit greater falls and cannot recover balance during higher perturbation intensities. Thus, they might need supplemental agents for fall prevention or even to be included in a perturbation-based protocol. Functional electrical stimulation is a widely used clinical modality for improving gait performance; however, it remains unknown whether it can enhance or interfere with reactive balance control. METHODS: We recruited twelve ambulatory participants with hemiparetic stroke (61.48 ± 6.77 years) and moderate-to-high motor impairment (Chedoke-McMaster Stroke Leg Assessment ≤ 4/7). Each participant experienced 4 unpredicted paretic gait-slips, with and without functional electrical stimulation (provided 50-500 ms after perturbation) in random order. The paretic quadriceps muscle group was chosen to receive electrical stimulation, considering the role of support limb knee extensors for preventing limb-collapse. Outcomes including primary (laboratory falls), secondary (reactive stability, vertical limb support) and tertiary (compensatory step length, step initiation, execution time) measures were compared between the two conditions. RESULTS: Participants demonstrated fewer falls, higher reactive stability, and higher vertical limb support (p < 0.05) following gait-slips with functional electrical stimulation compared to those without. This was accompanied by reduced step initiation time and a longer compensatory step (p < 0.05). CONCLUSION: The application of functional electrical stimulation to paretic quadriceps following gait-slips reduced laboratory fall incidence with enhanced reactive balance outcomes among people with higher stroke-related motor impairment. Our results lay the preliminary groundwork for understanding the instantaneous neuromodulatory effect of functional electrical stimulation in preventing gait-slip falls, future studies could test its therapeutic effect on reactive balance. Clinical registry number: NCT04957355.