Trajectories of health conditions and their associations with the risk of cognitive impairment among older adults: insights from a national prospective cohort study.

BACKGROUND: The associations between trajectories of different health conditions and cognitive impairment among older adults were unknown. Our cohort study aimed to investigate the impact of various trajectories, including sleep disturbances, depressive symptoms, functional limitations, and multimorbidity, on the subsequent risk of cognitive impairment. METHODS: We conducted a prospective cohort study by using eight waves of national data from the Health and Retirement Study (HRS 2002-2018), involving 4319 adults aged 60 years or older in the USA. Sleep disturbances and depressive symptoms were measured using the Jenkins Sleep Scale and the Centers for Epidemiologic Research Depression (CES-D) scale, respectively. Functional limitations were assessed using activities of daily living (ADLs) and instrumental activities of daily living (IADLs), respectively. Multimorbidity status was assessed by self-reporting physician-diagnosed diseases. We identified 8-year trajectories at four examinations from 2002 to 2010 using latent class trajectory modeling. We screened participants for cognitive impairment using the 27-point HRS cognitive scale from 2010 to 2018 across four subsequent waves. We calculated hazard ratios (HR) using Cox proportional hazard models. RESULTS: During 25,914 person-years, 1230 participants developed cognitive impairment. In the fully adjusted model 3, the trajectories of sleep disturbances and ADLs limitations were not associated with the risk of cognitive impairment. Compared to the low trajectory, we found that the increasing trajectory of depressive symptoms (HR = 1.39; 95% CI = 1.17-1.65), the increasing trajectory of IADLs limitations (HR = 1.88; 95% CI = 1.43-2.46), and the high trajectory of multimorbidity status (HR = 1.48; 95% CI = 1.16-1.88) all posed an elevated risk of cognitive impairment. The increasing trajectory of IADLs limitations was associated with a higher risk of cognitive impairment among older adults living in urban areas (HR = 2.30; 95% CI = 1.65-3.21) and those who smoked (HR = 2.77; 95% CI = 1.91-4.02) (all P for interaction < 0.05). CONCLUSIONS: The results suggest that tracking trajectories of depressive symptoms, instrumental functioning limitations, and multimorbidity status may be a potential and feasible screening method for identifying older adults at risk of cognitive impairment.

Waistline to thigh circumference ratio as a predictor of MAFLD: a health care worker study with 2-year follow-up.

BACKGROUND: This study aimed to determine whether the waist-to-thigh ratio (WTTR) is associated with the incidence of metabolic-associated fatty liver disease (MAFLD) in health care workers. METHODS: There were 4517 health care workers with baseline data and results from 2 follow-up examinations. We divided the subjects into 3 groups according to baseline WTTR and used the Cox hazard regression model to estimate MAFLD risk. RESULTS: The WTTRs were categorized by tertiles at baseline using the values 1.58 and 1.66. Patients with higher WTTR tended to have significantly greater values for the following factors, body mass index (BMI), fasting blood glucose (FPG), systolic blood pressure, diastolic blood pressure, total cholesterol (TC), triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C) and neck circumference. The incidence of MAFLD significantly increased with increasing WTTR tertiles (5.74%, 12.75% and 22.25% for the first, second and third tertiles, respectively, P < 0.05 for trend). Kaplan-Meier(K-M) survival analysis revealed a significant tendency towards increased MAFLD risk with increasing WTTR tertile. In the fully adjusted model, the hazard ratios (95% CIs) for MAFLD in the second, third WTTR tertiles compared with the first quartile were 2.17(1.58,2.98), 3.63(2.70,4.89), respectively, third neck circumference tertiles compared with the first quartile were 2.84(1.89,4.25), 8.95(6.00,13.35), respectively. Compared with those of individuals with a BMI > 23 kg/m2, the associations between WTTR and MAFLD incidence were more pronounced in subjects with a BMI < 23 kg/m2. Similarly, the difference in neck circumference was more pronounced in these patients with a BMI < 23 kg/m2. CONCLUSIONS: Our results revealed that the WTTR is an independent risk factor for MAFLD, and there was a dose‒response relationship between the WTTR and MAFLD risk. The neck circumference was significantly different in subjects with a BMI < 23 kg/m2. This approach provides a new way to predict the incidence rate of MAFLD.

Association between triglyceride-glucose index trajectories and carotid atherosclerosis progression.

BACKGROUND: The triglyceride-glucose (TyG) index has been recognized as being an alternative cardiometabolic biomarker for insulin resistance associated with the development and prognosis of cardiovascular disease (CVD). However, the prospective relationship between baseline and long-term trajectories of the TyG index and carotid atherosclerosis (CAS) progression has yet to be investigated. METHODS: This longitudinal prospective cohort study included 10,380 adults with multiple general health checks at Peking University Third Hospital from January 2011 to December 2020. The TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). The latent class trajectory modeling method was used to analyze the TyG index trajectories over the follow-up. Based on univariate and multivariate Cox proportional hazards analyses, hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for the baseline and trajectory of the TyG index. RESULTS: During a median follow-up period of 757 days, 1813 participants developed CAS progression. Each 1-standard deviation (SD) increase in the TyG index was associated with a 7% higher risk of CAS progression after adjusting for traditional CVD risk factors (HR = 1.067, 95% CI 1.006-1.132). Similar results were observed when the TyG index was expressed as quartiles. According to different trajectory patterns, participants were categorized into low-stable, moderate-stable, and high-increasing groups. After multivariate adjustment, the moderate-stable group had a 1.139-fold (95% CI 1.021-1.272) risk of CAS progression. The high-increasing trajectory of the TyG index tended to be associated with CAS progression (HR = 1.206, 95% CI 0.961-1.513). CONCLUSIONS: Participants with higher baseline and moderate-stable trajectory of the TyG index were associated with CAS progression. Long-term trajectories of the TyG index can help to identify individuals at a higher risk of CAS progression who deserve specific preventive and therapeutic approaches.

Association of magnesium sulfate use with mortality in critically ill patients with sepsis: a retrospective propensity score-matched cohort study.

BACKGROUND: Trials have demonstrated lower rates of acute kidney injury in critically ill patients receiving magnesium supplementation, but they have yielded conflicting results regarding mortality. METHODS: This is a retrospective cohort study based on the MIMIC-IV (Medical Information Mart in Intensive Care-IV) database. Adult critically ill patients with sepsis were included in the analysis. The exposure was magnesium sulfate use during ICU stay. The primary outcome was 28-day all-cause mortality. Propensity score matching (PSM) was conducted at a 1:1 ratio. Multivariable analyses were used to adjust for confounders. RESULTS: The pre-matched and propensity score-matched cohorts included 10 999 and 6052 patients, respectively. In the PSM analysis, 28-day all-cause mortality rate was 20.2% (611/3026) in the magnesium sulfate use group and 25.0% (757/3026) in the no use group. Magnesium sulfate use was associated with lower 28-day all-cause mortality (hazard ratio [HR], 0.70; 95% CI, 0.61-0.79; P<0.001). Lower mortality was observed regardless of baseline serum magnesium status: for hypomagnesaemia, HR, 0.64; 95% confidence interval (CI), 0.45-0.93; P=0.020; for normomagnesaemia, HR, 0.70; 95% CI, 0.61-0.80; P<0.001. Magnesium sulfate use was also associated with lower ICU mortality (odds ratio [OR], 0.52; 95% CI, 0.42-0.64; P<0.001), lower in-hospital mortality (OR, 0.65; 95% CI, 0.55-0.77; P<0.001), and renal replacement therapy (OR, 0.67; 95% CI, 0.52-0.87; P=0.002). A sensitivity analysis using the entire cohort also demonstrated lower 28-day all-cause mortality (HR, 0.62; 95% CI, 0.56-0.69; P<0.001). CONCLUSIONS: Magnesium sulfate use was associated with lower mortality in critically ill patients with sepsis. Prospective studies are needed to verify this finding.

Trends of underweight, overweight, and obesity among older adults in China from 2008 to 2018: a national observational survey.

OBJECTIVE: This study aims to investigate the 10-year trends and disparities in underweight, overweight, and obesity among older adults aged 65 years and older in China from 2008 to 2018. METHODS: We used four waves (2008, 2011, 2014, and 2018) of data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a national community-based cross-sectional survey conducted every 2-3 years. Body weight and height were measured by trained assessors following standardized procedures. BMI was calculated and divided into underweight (< 18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), obese (≥ 30.0 kg/m2) according to WHO reference. Multinomial logistic regression models were used to examine factors related with abnormal BMI groups, after adjusting for potential confounders. RESULTS: Among 46,543 older adults in China, the prevalence rates of underweight decreased with each survey year from 2008 to 2018, declining from 20.05 to 7.87% (p < 0.001). In contrast, the prevalence rates of overweight and obesity showed an increasing trend (all p < 0.001). Specifically, the prevalence of overweight rose from 12.82% to 2008 to 28.45% in 2018, and the prevalence of obesity increased from 1.62% to 2008 to 4.95% in 2018. In the multinomial logistic regression model, survey year, gender, residence, marital status, economic status, numbers of chronic diseases, smoking status, sleep quality, and functional disability were factors related with obesity. CONCLUSION: The prevalence rates of overweight and obesity were increasing while the prevalence of underweight and normal weight significantly decreased from 2008 to 2018 among older adults in China, which poses a huge challenge for chronic disease. There is an urgent need for intervention policy planning and early prevention of abnormal body weight for the preparation of an aging society.

Methamphetamine-mediated dissemination of ß-amyloid: Disturbances in endocytosis, transport and clearance of ß-amyloid in microglial BV2 cells.

Methamphetamine (Meth) abuse can cause neurodegenerative-like changes, such as those observed in Alzheimer's disease (AD), characterized by extracellular amyloid-ß (Aß) deposition. The "spreading hypothesis" suggests that pathological Aß spreads over the entire brain, which depends on Aß endocytosis, transport and clearance. However, whether Meth exposure impacts these effects remains poorly understood. Microglia play an important role in the clearance of Aß. Therefore, the effects of microglia on Aß ingestion, degradation, and efflux under Meth challenge were investigated. Meth significantly engulfed and elicited a massive accumulation of Aß42 when extracellular administration of FAM-Aß42, accompanied by an increase in endocytosis-associated mRNA and protein expression, including TREM2 and VSP35. Meanwhile, FAM-Aß42 degradation was obviously retarded, since the colocalization of Aß42 and LDL, Aß42 and lysosomes was decreased, and syntaxin 17 might be involved in this process. Intriguingly, Meth dramatically facilitated FAM-Aß42 dissemination in microglia, characterized by the massive overlap between FAM-Aß42 and transferrin, which is destined to be excreted out of the cells. The facilitation of FAM-Aß42 spreading was further validated by the increased colocalization of FAM-Aß42 and CD63. Mechanistically, Meth mediated Aß42 spreading through the exosomal pathway, since an exosomal inhibitor remarkably hindered this process. Therefore, the current study elucidated a novel mechanism of Meth-induced accelerated progression in neurodegenerative disease, and targeting the inhibition of Aß1-42 efflux in microglia might provide beneficial effects for Meth-induced neural damage.

Sequential use of midazolam and dexmedetomidine for long-term sedation may reduce weaning time in selected critically ill, mechanically ventilated patients: a randomized controlled study.

BACKGROUND: Current sedatives have different side effects in long-term sedation. The sequential use of midazolam and dexmedetomidine for prolonged sedation may have distinct advantages. We aimed to evaluate the efficacy and safety of the sequential use of midazolam and either dexmedetomidine or propofol, and the use of midazolam alone in selected critically ill, mechanically ventilated patients. METHODS: This single-center, randomized controlled study was conducted in medical and surgical ICUs in a tertiary, academic medical center. Patients enrolled in this study were critically ill, mechanically ventilated adult patients receiving midazolam, with anticipated mechanical ventilation for ≥ 72 h. They passed the spontaneous breathing trial (SBT) safety screen, underwent a 30-min-SBT without indication for extubation and continued to require sedation. Patients were randomized into group M-D (midazolam was switched to dexmedetomidine), group M-P (midazolam was switched to propofol), and group M (sedation with midazolam alone), and sedatives were titrated to achieve the targeted sedation range (RASS - 2 to 0). RESULTS: Total 252 patients were enrolled. Patients in group M-D had an earlier recovery, faster extubation, and more percentage of time at the target sedation level than those in group M-P and group M (all P < 0.001). They also experienced less weaning time (25.0 h vs. 49.0 h; HR1.47, 95% CI 1.05 to 2.06; P = 0.025), and a lower incidence of delirium (19.5% vs. 43.8%, P = 0.002) than patients in group M. Recovery (P < 0.001), extubation (P < 0.001), and weaning time (P = 0.048) in group M-P were shorter than in group M, while the acquisition cost of sedative drug was more expensive than other groups (both P < 0.001). There was no significant difference in adverse events among these groups (all P > 0.05). CONCLUSIONS: The sequential use of midazolam and dexmedetomidine was an effective and safe sedation strategy for long-term sedation and could provide clinically relevant benefits for selected critically ill, mechanically ventilated patients. TRIAL REGISTRATION: NCT02528513 . Registered August 19, 2015.

Effects of tree canopy on psychological distress: A repeated cross-sectional study before and during the COVID-19 epidemic.

BACKGROUND: During the COVID-19 epidemic period, people showed a stronger connection to the environment within their communities. Although tree canopy in residential areas has been shown to positively affect psychological distress, it is not clear whether the COVID-19 epidemic played a role in this process. Elucidation of the relationship between tree canopy and the impact on psychological distress during the COVID-19 epidemic could provide valuable information as to the best methods to help individuals cope with urban mental stress events. METHODS: A total of 15 randomly selected residential areas of Beijing were enrolled in this repeated cross-sectional study. A total of 900 residents were included in the two-waves of the investigation (450 residents per wave) before and during the COVID-19 epidemic (i.e., May 2019 and May 2020). Psychological distress was estimated using the 12-question General Health Questionnaire (GHQ-12). Tree canopy coverage (TCC) was measured through visual interpretation based on the 2013 data sources (World View 2 satellite imagery of Beijing urban areas with a resolution of 0.5 m). The demographic characteristics, distance to the nearest surrounding green or blue space, residential area house price, household density, and construction year were also collected in this study. A multivariate logistic regression, relative risk due to interaction (RERI), and synergy index (SI) were used to explore the relationships among tree canopy, COVID-19, and psychological distress. RESULTS: The negative impact of the COVID-19 epidemic on mental health was significant, with the prevalence of psychological distress increased 7.84 times (aOR = 7.84, 95% CI = 4.67-13.95) during the COVID-19 epidemic period. Tree canopy coverage in the group without psychological distress was significantly higher than that of the psychologically distressed group (31.07 ± 11.38% vs. 27.87 ± 12.97%, P = 0.005). An increase in 1% of TCC, was related to a 5% decrease in the prevalence of psychological distress (aOR = 0.95, 95% CI = 0.93-0.98). An antagonism joint action between tree canopy and the COVID-19 epidemic existed (RERI = 1.09, 95% CI = 0.72-1.47; SI = 0.16, 95% CI = 0.05-0.52), and persisted enhancing only in medium (26.45%-33.21%) and above TCC level. Correlation of GHQ items and TCC significantly differed between the COVID-19 non-epidemic and epidemic periods, with the effects of tree canopy on GHQ-12 items covering topics, such as social function and depression, presumably absent because of epidemic limitations. CONCLUSIONS: This study indicates that the COVID-19 epidemic harmed mental health and verified the positive effects of residential tree canopy on psychological distress in Beijing. We suggest paying more attention to residents in areas of low TCC and dealing with psychological distress caused by public health stress events based on tree canopy strategies.

Association between risk perception and influenza vaccine hesitancy for children among reproductive women in China during the COVID-19 pandemic: a national online survey.

BACKGROUND: In China, the national prevalence of parental influenza vaccine hesitancy (IVH) during the pandemic of coronavirus disease 2019 (COVID-19), and the association between risk perception and parental IVH are still unclear. We aimed to explore the association between risk perception and IVH for children among reproductive women in China, a poorly studied area. METHODS: From December 14, 2020, to January 31, 2021, we conducted a national anonymous online survey on IVH for children among reproductive women in China. We assessed risk perception including perceived susceptibility, severity, barriers, and benefits using the Health Belief Model and then classified each variable into three groups based on tertiles. Logistic regression models were used to calculate the adjusted odds ratio (aOR) of risk perception related to vaccine hesitancy after controlling for sociodemographic characteristics, health status, and knowledge of influenza, among other factors. Additionally, subgroup analysis was performed. RESULTS: Among 3,011 reproductive women, 9.13% reported IVH. In multivariable models, vaccine hesitancy was associated with low perceived susceptibility (aOR = 2.55, 95% CI: 1.79-3.65), higher perceived barriers (moderate: aOR = 1.47, 95% CI: 1.04-2.08; high: aOR = 2.20, 95% CI: 1.47-3.30), and low perceived benefit (moderate: aOR = 1.40, 95% CI: 1.03-1.92; low: aOR = 2.10, 95% CI: 1.43-3.07). Subgroup analysis showed that vaccine hesitancy was more likely to occur among women with high perceived barriers aged < 30 years compared with those older than 30 years (P for difference = 0.041) and among women with moderate perceived benefit who had never conceived compared with those had a history of pregnancy (P for difference = 0.048). CONCLUSIONS: Nearly one in 10 reproductive women was hesitant about influenza vaccination for their children during the COVID-19 pandemic. To mitigate vaccine hesitancy, our findings highlight a need for tailored public health measures to increase perceived disease susceptibility and vaccine benefit and decrease perceived barriers. Furthermore, the effect of high perceived barriers and moderate perceived benefit on vaccine hesitancy was higher among younger women and women who had never conceived.

Banner cloud sign: a novel method for the diagnosis of dural ossification in patients with thoracic ossification of the ligamentum flavum.

PURPOSE: Dural ossification (DO) is common in patients with ossification of the ligamentum flavum (OLF) and is the leading cause of dural tears. However, the methods used for DO diagnosis are limited. The purpose of this study was to propose a novel CT-based imaging sign, Banner cloud sign (BCs), and clarify its clinical characteristics and correlations with DO. METHODS: 57 OLF patients who underwent thoracic spine decompression surgery in our single-center between January- and October-2018 were recruited and divided into two groups based on the presence of DO. Patient demographics and radiographic data were analyzed. Hematoxylin-eosin staining and micro-CT were used to detect the micro-morphological changes of DO. The diagnostic value of BCs for DO was assessed by sensitivity and specificity. RESULTS: 12 patients with a total of 19 segments were diagnosed as DO. The incidence of DO was 21.1% (12/57) in OLF patients and 9.5% (19/200) in OLF segments. Patients with DO had a shorter disease duration and a higher incidence of cerebrospinal fluid leakage than those without DO. Hematoxylin-eosin staining and micro-CT showed that the dura mater was ossified and fused with ossified ligamentum flavum, and diffusion along the dura mater, like a banner cloud flying on the mountain. The sensitivity and specificity of BCs in DO diagnosis were 78.9 and 90.6%, respectively. CONCLUSION: BCs can vividly and intuitively describe the imaging features of DO and has high diagnostic accuracy. It could be a promising and valuable method for the diagnosis of DO.

The effect of physical activity interventions on cognition function in patients with diabetes: A systematic review and meta-analysis.

BACKGROUND: In recent years, studies have revealed that cognition may be impaired by glucose metabolism disorder. Meanwhile, physical activity has been demonstrated to maintain blood glucose. This meta-analysis was conducted to assess the effect of physical activity on cognition in patients with diabetes and provide evidence for the treatment of cognition impairment among them. METHODS: We searched studies published in five databases from 1 January 1984 to 29 August 2020. A random-effect or fixed-effect meta-analysis was used to estimate the pooled effect of physical activity on the change of cognition throughout intervention duration and post-intervention cognition scores by standardized mean difference (SMD) and its 95% confidence interval (CI). We used funnel plots to evaluate the publication bias, I2 statistic to evaluate the heterogeneity and did subgroup analysis stratified by sample size and follow-up time. RESULTS: Five eligible studies involving 2581 patients with diabetes were included. The pooled effect of physical activity on cognition improvement in patients with diabetes was significant (SMD = 0.98, 95% CI: 0.34-1.62), while the effect on post-intervention cognition scores was not significant (SMD = 0.35, 95% CI: -0.04-0.73). In the subgroup analysis, the pooled effect was significantly higher in studies of follow-up time less than 1 year (SMD = 2.14, 95% CI: 1.63-2.64), while observing no significant effect in studies of follow-up time over 1 year (SMD = 0.10, 95% CI: -0.11-0.32). CONCLUSIONS: Physical activity is beneficial to improving cognition in patients with diabetes. However, the long-term effect needs to be explored in future studies.

Association between biomass fuel use and the risk of cognitive impairment among older populations in China: a population-based cohort study.

BACKGROUND: Cohort studies on the impact of biomass fuel use for cooking on cognitive impairment among older population are still lacking in China and elsewhere. The aim of this study was to examine whether biomass fuel use for cooking is associated with cognitive impairment in Chinese adults aged 65 years or older. METHODS: The prospective population-based cohort study of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) included participants aged 65 years or older in 2014 who were followed-up until 2018 in 23 provinces in China. The Mini-Mental State Examination (MMSE) was used to assess cognitive function, and cognitive impairment was defined as total MMSE scores less than 18. The association between biomass fuel use and cognitive impairment was evaluated using the Cox proportional hazards model. RESULTS: Of the 4145 participants included at baseline, participants who reported that they used biomass fuel for cooking (40.43%; IR: 3.11 versus 2.77 per 100 person-years; aHR: 1.27, 95% CI: 1.02-1.58) had a higher risk of cognitive impairment compared with participants who used clean fuels (53.75%). A stratified analyses showed greater effect estimates of cognitive impairment in the older people that lived in the rural areas (aHR: 1.444, 95% CI: 1.08-3.90) and never smoked (aHR: 1.33, 95% CI: 1.04-1.71). CONCLUSIONS: These findings demonstrated that biomass fuel used for cooking was associated with cognitive impairment, as defined by MMSE, in a population-based study of elderly in China. To prevent cognitive impairment, the structure of cooking fuels requires improvements.

Acceptance of seasonal influenza vaccination and associated factors among pregnant women in the context of COVID-19 pandemic in China: a multi-center cross-sectional study based on health belief model.

BACKGROUND: Seasonal influenza can circulate in parallel with coronavirus disease (COVID-19) in winter. In the context of COVID-19 pandemic, the risk of co-infection and the burden it poses on healthcare system calls for timely influenza vaccination among pregnant women, who are the priority population recommended for vaccination. We aimed to evaluate the acceptance of influenza vaccination and associated factors among pregnant women during COVID-19 pandemic, provide evidence to improve influenza vaccination among pregnant women, help reduce the risk of infection and alleviate the burden of healthcare system for co-infected patients. METHODS: We conducted a multi-center cross-sectional study among pregnant women in China. Sociodemographic characteristics, health status, knowledge on influenza, attitude towards vaccination, and health beliefs were collected. Locally weighted scatterplot smoothing regression analysis was used to evaluate the trends in the acceptance of influenza vaccine. Logistic regression was applied to identify factors associated with vaccination acceptance. RESULTS: The total acceptance rate was 76.5% (95%CI: 74.8-78.1%) among 2568 pregnant women enrolled. Only 8.3% of the participants had a history of seasonal influenza vaccination. In the logistic regression model, factors associated with the acceptance of influenza vaccine were western region, history of influenza vaccination, high knowledge of influenza infection and vaccination, high level of perceived susceptibility, perceived benefit, cues to action and low level of perceived barriers. Among 23.5% of the participants who had vaccine hesitancy, 48.0% of them were worried about side effect, 35.6% of them lacked confidence of vaccine safety. CONCLUSIONS: Our findings highlighted that tailored strategies and publicity for influenza vaccination in the context of COVID-19 pandemic are warranted to reduce pregnant women's concerns, improve their knowledge, expand vaccine uptake and alleviate pressure for healthcare system.

Tourism experiences and the lower risk of mortality in the Chinese elderly: a national cohort study.

BACKGROUND: Cohort studies about the effects of tourism experiences on the risk of death among Chinese older adults are still lacking. We aimed to examine the association between tourism experiences and mortality in Chinese aged 65 or above. METHODS: We included 9520 participants aged 65 years or above from the Chinese Longitudinal Healthy Longevity Survey at baseline in 23 provinces in 2011. They were followed up in 2014 and 2018. Cox proportional hazards models were used to assess the association between tourism experiences and the risk of death. RESULTS: Among 9520 participants, 7.85% had at least one tourism experience outside of their local city/county during the past 2 years. During 35,994.26 person-years of follow-up, in total 4635 deaths were observed. The crude rate of death was greater in participants who had no tourism experience than in older travelers (incidence rate: 13.70 versus 5.24 per 100 person-years). Elderly travelers had a significantly lower risk for all-cause mortality (crude hazard ratio: 0.38, 95% CI: 0.33-0.44) compared with non-travelers. After adjustment for all covariates, the risk of all-cause mortality was 27% lower among those with at least one tourism experience than among non-travelers (adjusted hazard ratio: 0.73, 95% CI: 0.62-0.85). Subgroup analysis showed that the associations between tourism and the decreased risk of mortality were stable. CONCLUSIONS: Tourism decreases the risk of mortality in the Chinese elderly. Tourism should be considered as a modifiable lifestyle factor and an effective way to reduce mortality and promote longevity and healthy aging.

Effects of physical activity on cognitive function among patients with diabetes in China: a nationally longitudinal study.

BACKGROUND: We aimed to examine the effect of physical activity on different cognitive domains among patients with diabetes. METHODS: We used two waves of data from the Chinese Health and Retirement Longitudinal Study (CHARLS, 2013-2015), a nationally representative dataset of Chinese population aged over 45. Total physical activity scores were calculated based on the International Physical Activity Questionnaire (IPAQ). Executive function and episodic memory were used as measures of cognitive function. We conducted lagged dependent variable models to explore the association between physical activity and cognitive function in full sample as well as two different age groups (45-65, ≥65). RESULTS: 862 diabetic patients were included. We found that diabetic participants who had greater level of physical activity at baseline were associated with better episodic memory function in 2 years (p < 0.05). Moreover, physical activity was significantly associated with less decline in episodic memory in fully adjusted models, and the associations were stronger among patients aged 45-65 years (p < 0.05). No statistically significant association was found between physical activity and executive function in all age groups. CONCLUSIONS: Physical activity may prevent some of the potential decline in episodic memory in diabetic patients. Clinicians and public health departments should strengthen the promotion of physical activity and develop early screening tools among diabetic participants to prevent the progression of cognitive impairment.

Features of colorectal cancer in China stratified by anatomic sites: A hospital-based study conducted in university-affiliated hospitals from 2014 to 2018.

OBJECTIVE: The clinical and biological characteristics of colorectal cancer have been found to differ depending on the anatomic site of the cancer. However, for Chinese patients, there is limited information on the proportion of cases at each site and the related features. In this study, we explored the location, distribution and other features of colorectal cancers at each anatomic site in Chinese patients. METHODS: We conducted a hospital-based study using hospitalization summary reports from 10 Peking University-affiliated hospitals from 2014 to 2018; the reports covered a total of 2,097,347 hospitalizations. Incident cases were chosen as the study population, and their epidemiological features were further analyzed. RESULTS: A total of 20,739 colorectal cancer patients were identified. Rectum was the most common location (48.3%) of the cancer, whereas the proportions of patients with distal and proximal colon cancer were 24.5% and 18.6%, respectively. Patients with rectal cancer were predominantly male and were the youngest for all anatomical sites (each P<0.001). The highest proportion of emergency admissions, the longest hospital stays and the highest hospitalization costs were found in patients with proximal colon cancer (each P<0.001). The proximal colon cancer subgroup included the highest proportions of patients with medical histories of cholecystectomy, cholecystolithiasis and/or gallbladder polyps and appendectomy (P=0.009, P<0.001 and P<0.001, respectively). The distal colon cancer subgroup included the highest proportions of patients with medical histories of diabetes and hypertension (P<0.001, respectively). CONCLUSIONS: The patterns of colorectal cancer observed in this study differ from those reported for Western patients and show a significantly higher proportion of patients with rectal cancer. Different epidemiological features were also found based on anatomic sites. Further studies based on tumor location should be conducted to facilitate more accurate screening and treatment.

Early intervention for heterotopic caesarean scar pregnancy to preserve intrauterine pregnancy may improve outcomes: a retrospective cohort study.

RESEARCH QUESTION: What is the best intervention time and method for patients who are diagnosed with heterotopic caesarean scar pregnancy (HCSP) wishing to preserve intrauterine pregnancy. DESIGN: Four patients diagnosed with HCSP from January 2014 to May 2019 were enrolled. Because HCSP is rare, data on 27 published cases were extracted to augment the analysis. Clinical characteristics and medical documents related to fetal reduction and subsequent maternal-neonate outcomes were analysed. RESULTS: The intervention time was significantly earlier in the full-term birth group (6.76 ± 1.05 weeks) compared with pre-term birth group (8.02 ± 1.55 weeks; P = 0.042). The cumulative full-term delivery rate was 91.48% when the intervention was at 6 weeks' gestation and decreased to 42.02% at 8 weeks. The maternal-neonate outcome was similar among the selective fetal reduction and surgical removal groups as was delivery time (34.68 ± 3.12 versus 34.80 ± 6.64 weeks; P = 0.955). In the four cases undergoing selective fetal reduction, the residual mass grew by 1.16-7.07 times compared with the area before reduction. The maximum size of the residual mass was observed at 12-13 weeks and 22-25 weeks. CONCLUSIONS: Most patients with HCSP who choose to keep intrauterine pregnancy will be able to carry the fetus to term. Selective fetal reduction would be the first intervention of choice and should take place immediately after diagnosis. The residual mass after reduction could continue to grow throughout the whole pregnancy, although this should not be considered as an indication for termination. With good supervision and careful management, the pregnancy could be maintained and carried to term.

Impact of Prior Ischemic Stroke on Outcomes in Patients With Heart Failure　- A Propensity-Matched Study.

BACKGROUND: Whether ischemic stroke per se, rather than older age or additional comorbidities, accounts for the adverse prognosis of heart failure (HF) is uncertain. The present study examineed the intrinsic association of ischemic stroke with outcomes in a propensity-matched cohort.Methods and Results:Of 1,351 patients hospitalized with HF, 388 (28.7%) had prior ischemic stroke. Using propensity score for prior ischemic stroke, estimated for each patient, a matched cohort of 379 pairs of HF patients with and without prior ischemic stroke, balanced on 32 baseline characteristics was assembled. At 30 days, prior ischemic stroke was associated with significantly higher risks of the combined endpoint of all-cause death or readmission (hazard ratio [HR]: 1.91; 95% confidence interval [CI]: 1.38 to 2.65; P<0.001), all-cause death (HR: 2.08; 95% CI: 1.28 to 3.38; P=0.003), all-cause readmission (HR: 2.67; 95% CI: 1.78 to 4.01; P<0.001), and HF readmission (HR: 2.11; 95% CI: 1.19 to 3.72; P=0.010). Prior ischemic stroke was associated with a significantly higher risk of all 4 outcomes at both 6 months and 1 year. CONCLUSIONS: Prior ischemic stroke was a potent and persistent risk predictor of death and readmission among patients with HF after accounting for clinical characteristics.

Clinical Outcomes of Intraoperative Contrast-Enhanced Ultrasound Compared with Intraoperative Neurophysiological Monitoring During Circumferential Decompression for Myelopathy Associated with Thoracic-Ossification of the Posterior Longitudinal Ligament.

BACKGROUND Circumferential decompression (CD) is an essential treatment option for myelopathy associated with thoracic-ossification of the posterior longitudinal ligament (T-OPLL) when laminectomy cannot achieve sufficient ventral decompression. Although intraoperative neurophysiological monitoring (IONM) is widely used, the operation has a relatively high risk. This study is the first to describe the use of contrast-enhanced ultrasound (CEUS) to evaluate the spinal cord blood flow (SCBF) during thoracic spine surgery in humans. The objective of this study was to compare clinical outcomes between intraoperative CEUS and IONM during CD. MATERIAL AND METHODS Sixty-eight T-OPLL patients who received CD from 2007 to 2014 were reviewed. All patients underwent IONM. CEUS was used on the following 2 occasions on 18 patients to evaluate SCBF: the first measurement was performed after laminectomy and the second after ventral decompression. Outcomes were evaluated by the Hirabayashi recovery rate (HRR). RESULTS The overall HRR of all patients was 56.7%. Regarding CEUS, the HRR was 20.0% in Group A (SCBF decreased) and 63.6% in Group B (SCBF increased), indicating a significantly poorer neurological outcome in Group A (P<0.01). Regarding IONM, the HRR did not significantly differ between Groups C (no meaningful change in potential), D (potential changed up to alert criteria), and E (potential improved). CONCLUSIONS IONM is relatively effective in detecting impending spinal cord dysfunction. Intraoperative CEUS is a safe and reliable method for assessing SCBF changes, which may be used as a supplement to IONM, thus reducing the incidence of false-negative results.