Social frailty and the incidence of motoric cognitive risk syndrome in older adults.

INTRODUCTION: Various associations between social factors and motoric cognitive risk syndrome (MCR) have been reported. However, whether social frailty (integrated from multiple social factors) is associated with MCR is still unclear. METHODS: We included 4657 individuals without MCR at Round 1 of the NHATS as the discovery sample, and 3075 newly recruited individuals from Round 5 of the NHATS as the independent validation sample. Social frailty was assessed by five social items. MCR was defined as the presence of both subjective cognitive complaints and slow gait speed in individuals without dementia or mobility disability. RESULTS: Compared with normal individuals, those with social frailty had higher risk of incident MCR (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.34-1.84). Each additional unfavorable social item was associated with an increased risk of MCR (HR: 1.32, 95% CI: 1.22-1.43). DISCUSSION: Social frailty was associated with an increased risk of incident MCR in older adults. HIGHLIGHTS: Various associations between social factors and motoric cognitive risk syndrome (MCR) have been reported. Social frailty that integrated from multiple social factors was associated with an increased risk of incident MCR. Social frailty should be included in the early screening of individuals to identify those at higher risk of MCR.

Assessment of Physical Resilience Using Residual Methods and Its Association With Adverse Outcomes in Older Adults.

Background and Objectives: Physical resilience (PR) is recognized as the ability to recover from the adverse effects of a stressor. However, there is a lack of consensus on how to optimally measure PR in older adults in general. We aimed to measure PR using residuals from regression analyses and investigated its association with adverse outcomes in older adults. Research Design and Methods: A total of 6 508 older adults were included from the National Health and Aging Trends Study, which was a population-based prospective cohort study. PR was assessed using residual methods from a linear model regressing the short physical performance battery on clinical diseases, age, sex, race/ethnicity, and health condition. Adverse outcomes included all-cause mortality, falls, and overnight hospitalization. Results: The mean age was 77.48 (7.84) years. Increased PR was associated with a lower risk of all-cause mortality (hazard ratio [HR] = 0.85, 95% confidence interval [CI]: 0.83-0.87). Compared to participants with reduced PR, those with normal PR had a lower risk for mortality (HR = 0.51, 95% CI: 0.46-0.56). Specifically, restricted cubic spline regression revealed a dose-response relationship between PR and all-cause mortality (p-overall < .0001, p-nonlinear = .011). Additionally, we also found significant associations of increased PR with lower risks of falls (HR = 0.98, 95% CI: 0.96-0.99) and overnight hospitalization (HR = 0.98, 95% CI: 0.97-1.00). Discussion and Implications: PR, measured by residual methods, was robustly and independently associated with all-cause mortality, falls, and overnight hospitalization. Our findings provide evidence that this approach may be a simple and feasible strategy to assess PR.

Clinical Significance of Preoperative Assessment of Intravesical Prostatic Protrusion in Radical Prostatectomy.

Background: Intravesical prostatic protrusion (IPP) is common in prostate-related diseases, whose clinical significance in radical prostatectomy was unknown. Methods: 791 patients underwent robot-assisted or open radical prostatectomy at our institution were enrolled. The transabdominal ultrasound examination of prostate and IPP was carried out preoperatively, by which IPP was classified as no (0-0.5cm, grade 0), slight (0.6-1.0cm, grade 1) and noticeable (>1.0cm, grade 2). Results: 185 (23.4%), 170 (21.5%) and 436 (55.1%) patients had no, slight and noticeable IPP, respectively. Generally, prostate specific antigen (PSA), Gleason score and pT stage increased with IPP grade. In particular, cases with grade 0 IPP had a decreased proportion of seminal vesicles' involvement than those with grade 1 and grade 2 IPP (p=0.035). Reconstruction of the bladder neck (in robot-assisted group), increased surgical bleeding (>200ml), and prolonged postoperative hospital stays (>14 days) happened more in patients with grade 2 IPP. Blood transfusion only happened in patients with noticeable IPP. PSM of bladder neck was only associated with higher IPP grade in open surgery group (p=0.032), not in robot-assisted surgery group. Conclusion: IPP is associated with cancer aggressiveness, surgery difficulty and PSM of bladder neck in prostate cancer. Assessment of it provides more information for operations.

Analysis and Design of a CLC/N Compensated CC-Type WPT System with Compact and Low-Cost Receiver.

Wireless power transfer (WPT) has been extensively studied by technicians for its advantages of safety, convenience and aesthetics. The load-independent constant current (CC) output is the focus of WPT research and has been initially applied in various fields, such as light-emitting diodes (LEDs) driving, CC charging of electric vehicles (EVs), etc. However, the existing CC-type WPT system has problems in that the output current is constrained by the loosely coupled transformer (LCT) parameters, the receiver is bulky, and the development cost is high. Therefore, this manuscript proposes a new CLC/None (CLC/N) compensated WPT system with a CC output function that eliminates the receiver-side compensation components, ensures the compactness of the receiver, and saves on production costs. The conditions for satisfying the CC output and zero-phase-angle (ZPA) operation of the proposed system are first discussed. Then, the detailed parameter design method is provided, and the characteristic that the output current is unconstrained by the LCT parameters is illustrated. In addition, the implementation of zero-voltage switching (ZVS) operation of the proposed system and the sensitivity of the changes of compensation components to the output current are analyzed in detail. Furthermore, to demonstrate the superiority of the proposed system, several other typical CC-type WPT systems are introduced for comparison. Finally, a confirmatory experimental prototype with an output current of 2 A is fabricated, and the experimental results are consistent with the theoretical analysis.

Disparities and Determinants of Cancer Treatment in Elderly Americans Living With Human Immunodeficiency Virus/AIDS.

Background: Previous studies suggest that human immunodeficiency virus (HIV)-infected cancer patients are less likely to receive cancer treatment. The extent to which this disparity affects the growing population of elderly individuals is unknown and factors that mediate these treatment differences have not been explored. Methods: We studied 930359 Americans aged 66-99 years who were diagnosed with 10 common cancers. Surveillance, Epidemiology, and End Results-Medicare claims from 1991 to 2011 were used to determine HIV status and receipt of cancer treatment in 6 months following diagnosis. Mediation analysis was conducted to estimate the direct effect of HIV, and indirect effect through cancer stage at diagnosis and comorbidities, on cancer treatment. Results: HIV-infected individuals (n = 687) were less likely to receive cancer treatment (70% vs 75% HIV uninfected; P < .01). This difference was larger in individuals aged 66-70 years, among whom only 65% were treated (vs 81% in HIV uninfected; P < .01), and time from cancer diagnosis to treatment was longer (median, 42.5 vs 36 days in HIV uninfected; P < .01). Accounting for potential confounders, HIV-infected individuals aged 66-70 years remained 20% less likely to receive cancer treatment (hazard ratio, 0.81 [95% confidence interval, .71-.92]). Seventy-five percent of this total effect was due to HIV itself, with a nonsignificant 24% mediated by cancer stage and comorbidities. Conclusions: Lowest cancer treatment rates were seen in the younger subset of HIV-infected individuals, who would likely benefit most from treatment in terms of life expectancy.

Bootstrapping data envelopment analysis of efficiency and productivity of county public hospitals in Eastern, Central, and Western China after the public hospital reform.

China implemented the public hospital reform in 2012. This study utilized bootstrapping data envelopment analysis (DEA) to evaluate the technical efficiency (TE) and productivity of county public hospitals in Eastern, Central, and Western China after the 2012 public hospital reform. Data from 127 county public hospitals (39, 45, and 43 in Eastern, Central, and Western China, respectively) were collected during 2012-2015. Changes of TE and productivity over time were estimated by bootstrapping DEA and bootstrapping Malmquist. The disparities in TE and productivity among public hospitals in the three regions of China were compared by Kruskal-Wallis H test and Mann-Whitney U test. The average bias-corrected TE values for the four-year period were 0.6442, 0.5785, 0.6099, and 0.6094 in Eastern, Central, and Western China, and the entire country respectively, with average non-technical efficiency, low pure technical efficiency (PTE), and high scale efficiency found. Productivity increased by 8.12%, 0.25%, 12.11%, and 11.58% in China and its three regions during 2012-2015, and such increase in productivity resulted from progressive technological changes by 16.42%, 6.32%, 21.08%, and 21.42%, respectively. The TE and PTE of the county hospitals significantly differed among the three regions of China. Eastern and Western China showed significantly higher TE and PTE than Central China. More than 60% of county public hospitals in China and its three areas operated at decreasing return scales. There was a considerable space for TE improvement in county hospitals in China and its three regions. During 2012-2015, the hospitals experienced progressive productivity; however, the PTE changed adversely. Moreover, Central China continuously achieved a significantly lower efficiency score than Eastern and Western China. Decision makers and administrators in China should identify the causes of the observed inefficiencies and take appropriate measures to increase the efficiency of county public hospitals in the three areas of China, especially in Central China.

Assessment of tris (1, 3-dichloro-2-propyl) phosphate toxicology in PC12 cells by using digital gene expression profiling.

Tris (1,3-dichloro-2-propyl) phosphate (TDCIPP), one of the most universally used organophosphate flame retardants (OPFRs), is an environmental pollutant. However, limited information is available regarding its toxicity and environmental health risk. In the present study, PC12 cells provided a useful model for the evaluation of the toxic effects of TDCIPP. Exposure to 7.5, 15, 30, or 60 µM TDCIPP for 72 h inhibited cell viability, and enhanced cellular apoptosis and oxidative stress. To further explore the underlying mechanisms, digital gene expression (DGE) technology was used to identify early transcriptional changes following TDCIPP exposure. Expression of the transcripts of 161 genes was significantly altered upon treatment with TDCIPP. Functional and pathway analysis of the transcriptional profile demonstrated that genes showing significant TDCIPP-associated changes in expression were involved in the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway, extracellular matrix-receptor interactions, protein digestion and absorption, and microRNAs in cancer. Using quantitative real-time PCR, we validated the differential expression of selected genes. These results showed that the expression profiles of cells exposed to 60 µM TDCIPP were consistent with the DGE data. Furthermore, western blotting showed that treatment with TDCIPP reduced the Bcl-2/Bax ratio and attenuated PI3K/Akt/Myc signaling. Taken together, these data suggest that TDCIPP exposure can reduce cell viability and induce apoptosis in PC12 cells by inhibiting activation of the PI3K/Akt/Myc signaling pathway. These observations provide valuable preliminary information regarding the mechanisms of TDCIPP-induced toxicity in PC12 cells and indicate that further study of the toxicity of other environmental OPFRs is warranted.

The zero ischemia index (ZII): a novel criterion for predicting complexity and outcomes of off-clamp partial nephrectomy.

PURPOSES: Although several anatomical classification systems that aimed to standardize the description of renal tumors were previously reported, a special classification system is required to help predict the complexity and perioperative outcomes of off-clamp nephron-sparing surgery (NSS). We developed a novel criterion-zero ischemia index (ZII), aiming to help predict the perioperative outcomes after off-clamp NSS and guide patient selection. METHODS: We retrospectively evaluated 149 patients between June 2009 and July 2014 in our institution who underwent off-clamp NSS with available computed tomography images. ZII was defined as the product of the tumor diameter and depth within renal parenchyma. ZII was then analyzed to investigate its association with perioperative outcomes. A specific ZII score was further selected to best guide patient selection in off-clamp NSS. RESULTS: ZII was significantly associated with estimated blood loss >500 mL (OR 1.270, 95% CI 1.036-1.557, p = 0.021), operative time >2 h (OR 1.286, 95% CI 1.051-1.573, p = 0.014), surgical complications (OR 1.251, 95% CI 1.035-1.511, p = 0.020), overall complications (OR 1.208, 95% CI 1.016-1.436, p = 0.032), and >10% decrease in estimated glomerular filtration rate (OR 1.362, 95% CI 1.045-1.776, p = 0.022). Patients with ZII > 6 may bear a higher risk of hemorrhage, perioperative complications, and a longer operative time, if they underwent an off-clamp NSS, compared to those with ZII ≤ 6. CONCLUSIONS: The ZII is a novel and readily measurable criterion which can help predict renal complexity of tumor and risk of perioperative outcomes after off-clamp NSS. ZII = 6 is established as a preliminary threshold for patient selection of off-clamp NSS. A more robust criterion is to be validated with more samples in a prospective study.