Comprehensive assessment of fine motor movement and cognitive function among older adults in China: a cross-sectional study.

BACKGROUND: Fine motor skills are closely related to cognitive function. However, there is currently no comprehensive assessment of fine motor movement and how it corresponds with cognitive function. To conduct a complete assessment of fine motor and clarify the relationship between various dimensions of fine motor and cognitive function. METHODS: We conducted a cross-sectional study with 267 community-based participants aged ≥ 60 years in Beijing, China. We assessed four tests performance and gathered detailed fine motor indicators using Micro-Electro-Mechanical System (MEMS) motion capture technology. The wearable MEMS device provided us with precise fine motion metrics, while Chinese version of the Montreal Cognitive Assessment (MoCA) was used to assess cognitive function. We adopted logistic regression to analyze the relationship between fine motor movement and cognitive function. RESULTS: 129 (48.3%) of the participants had cognitive impairment. The vast majority of fine motor movements have independent linear correlations with MoCA-BJ scores. According to logistic regression analysis, completion time in the Same-pattern tapping test (OR = 1.033, 95%CI = 1.003-1.063), Completion time of non-dominant hand in the Pieces flipping test (OR = 1.006, 95%CI = 1.000-1.011), and trajectory distance of dominant hand in the Pegboard test (OR = 1.044, 95%CI = 1.010-1.068), which represents dexterity, are related to cognitive impairment. Coordination, represented by lag time between hands in the Same-pattern tapping (OR = 1.663, 95%CI = 1.131-2.444), is correlated with cognitive impairment. Coverage in the Dual-hand drawing test as an important indicator of stability is negatively correlated with cognitive function (OR = 0.709, 95%CI = 0.6501-0.959). Based on the above 5-feature model showed consistently high accuracy and sensitivity at the MoCA-BJ score (ACU = 0.80-0.87). CONCLUSIONS: The results of a comprehensive fine-motor assessment that integrates dexterity, coordination, and stability are closely related to cognitive functioning. Fine motor movement has the potential to be a reliable predictor of cognitive impairment.

Environmental protection tax and green innovation.

How environmental taxes affect green innovation in businesses is closely related to enterprise sustainable development and green economic development. This study uses the data of non-financial listed companies from 2010 to 2020 in China, and adopts the difference-in-difference method to examine the effect of the environmental protection tax (EPT) on corporate green innovation in China. Results show that EPT reform has a significantly negative effect on corporate green innovation, and the robustness test supports this result. EPT has a larger inhibitory effect on non-state-owned enterprises' green innovation than state-owned enterprises. This inhibiting effect is particularly prominent in companies situated in northern and low-marketization regions. Further analysis shows that EPT affects enterprises' green innovation by reducing the cash flow and financing of enterprises. This study provides an empirical basis for the implementation of the EPT policy.

Is there gender inequality in the impacts of energy poverty on health?

This paper aims to study the gender inequality in the health impacts of energy poverty. Using the Chinese Family Panel Studies (CFPS) 2018 data, we examine the gender heterogeneous effects of energy poverty on residents' health. The empirical results indicate that energy poverty would increase the ratio of respiratory disease, hospitalization as well as the healthcare expenditure. The effects are moderated by housework time. Moreover, we explore the gender inequality of the health impacts and find that women's health is more severely impaired and the effect of gender inequality is heterogeneous between urban and rural areas. We further investigate the historical origins of intra-household division of labor and reveal that the root of gender inequality in the health effects of energy poverty is status inequality. The government should give the first priority to energy poverty alleviation through modern energy network construction. Providing the energy-deprived families with ventilation equipment and medical insurance should be considered as the next step. Finally, it is imperative to eradicate urban-rural dual structure and legislate to ensure gender equality in the whole society.

Hematopoietic Stem-Cell Transplantation versus Immunosuppressive Therapy in Patients with Adult Acquired Severe Aplastic Anemia: A Cost-Effectiveness Analysis.

OBJECTIVE: Controversy remains regarding which therapy to initially select for severe aplastic anemia (SAA) patients aged 35-50. This cost-effectiveness analysis aimed to use the Markov model to compare immunosuppressive therapy (IST) with hematopoietic stem-cell transplantation (HSCT) in age-stratified patients with SAA. METHODS: A cost-effectiveness analysis using a Markov model compared IST with HSCT in age-stratified patients with SAA. Baseline data were derived from a systematic literature review and collected from Huashan Hospital, Fudan University. The primary outcome was an incremental cost-effectiveness ratio (ICER). RESULTS: The HSCT strategy dominated in patients aged 18-35 even though it was $146,970 more expensive than IST, and the ICER of HSCT to IST was $14,054.19/quality-adjusted life-year (QALY), which was less than the willingness-to-pay value of $25,397.57/QALY. The IST strategy dominated in patients aged 35-50, because it was $72,009 less expensive than HSCT and yielded 3.24 QALYs more than HSCT. The model was vigorous in the sensitivity analyses of the key variables tested through the plausible ranges that were acquired from costing sources and previously published literature. CONCLUSION: The preferred induction strategy for patients aged 18-35 with SAA appears to be HSCT, and the preferred strategy for patients aged 35-50 is IST, which minimizes costs while maximizing QALYs.

PET/CT metabolic patterns in systemic immune activation: A new perspective on the assessment of immunotherapy response and efficacy.

Despite advances in immunotherapy, extensive challenges remain in its clinical application. Positron emission tomography (PET)/computed tomography (CT) is widely used in the diagnosis and follow-up of malignant tumors and in the prediction of treatment outcomes. Successful cancer immunotherapy requires systemic immune activation. In addition to local immune responses, a systemic antitumor response involving primary and secondary lymphoid organs is required for tumor eradication. Immune-related adverse events (IRAEs) are considered to be a manifestation of excessive immune activation. PET/CT can monitor the metabolic changes in peripheral lymphoid organs and related organs. Thus, it can identify patients with effective immune activation and predict the efficacy and outcomes of immunotherapy. This review aimed to investigate the theoretical basis and feasibility of applying PET/CT for monitoring the immune activation status of peripheral lymphoid organs after immunotherapy and predict its effectiveness. Towards this goal, we reviewed the cellular components and structural composition of peripheral lymphoid organs, as well as their functions in the systemic immune response. We analyzed the theoretical basis and feasibility of applying PET/CT to monitor the immune activation status of peripheral lymphoid organs after immunotherapy to predict the effectiveness of immunotherapy.

Optimization of tigecycline dosage regimen for different infections in the patients with hepatic or renal impairment.

OBJECTIVE: The objective of this study was to investigate the cumulative fraction of response (CFR) of various tigecycline dosing regimens in patients with hepatic or renal impairment. METHODS: Monte Carlo simulations were performed using pharmacokinetic parameters and microbiological data to evaluate various tigecycline regimens in patients with hepatic or renal impairment. RESULTS: For HAP and cIAI, the regimen of 25 mg q12h achieved CFR values of >90% in Child-Pugh C patients against Gram-positive bacteria and partial Gram-negative bacteria (Escherichia coli and Klebsiella oxytoca). However, dose increases of tigecycline was mostly required for Enterobacter cloacae, Klebsiella pneumoniae and Acinetobacter baumanni. The conventional tigecycline regimen (50 mg q12h) was effective for HAP and cIAI caused by Gram-positive bacteria and Escherichia coli in patients with renal impairment. For HAP caused by Klebsiella pneumoniae and Enterobacter cloacae, patients with severe renal failure can use the standard dose regimen 50 mg q12h, and other patients need to increase the dose of tigecycline. However, when treating cSSSI caused by Acinetobacter baumannii, Enterobacter cloacae and Klebsiella pneumoniae, all tigecycline maintenance doses have a CFR <90%. CONCLUSIONS: It is necessary to optimize tigecycline dosage regimens in patients with hepatic or renal impairment in order to maximise clinical response and minimise the probability of exposure-related toxicity.

[Indication of bloodletting therapy based on multi-dimensional evidence assessment].

The indication of bloodletting therapy was determined based on the multi-dimensional evidence assessment, which could provide guidance for the clinical application of bloodletting therapy. The literature of bloodletting therapy was comprehensively collected by retrieval in CNKI, Wanfang and VIP databases (until February 23, 2019), modern books in Library of Tianjing University of TCM and the Chinese Medical Code (Fifth Edition). The disease spectrum of bloodletting therapy was determined by self-designed questionnaire survey e-mailed to relevant experts. The indication of bloodletting therapy was determined by Delphi expert meeting. As a result, 746 pieces of ancient literature and 32 775 modern literature were included. The indications of bloodletting therapy based on the multi-dimensional evidence assessment include herpes zoster, acne, acute tonsillitis, vascular headache, varicose veins of lower extremities, acute lumbar sprain, early erysipelas, wheat swelling, exogenous fever of children, stroke, which are mainly the syndromes of blood stasis, toxin, excess and heat.

[Particle Size Distribution and Human Health Risk Assessment of Heavy Metals in Atmospheric Particles from Beijing and Xinxiang During Summer].

Under a condition of good air quality (AQI:55-90, PM10:37-97 µg·m-3, PM2.5:17-76 µg·m-3), six groups of 54 samples were collected using an Andersen cascade impactor from both the indoor and outdoor stations in Beijing and Xinxiang from June to August in 2016. The samples were digested by microwave digestion, and nine heavy metal elements (Pb, Cr, Ni, Cu, Zn, As, Cd, Mn, and Co) in the atmospheric particles were determined with an inductively coupled plasma source mass spectrometer (ICP-MS). The results showed that the enrichment index (0-3) of most elements were low in both cities except for Cd[15.0 (Beijing) and 8.47 (Xinxiang)]. Cr, Co, Cu, and Mn in the atmospheric particles from Beijing park, Cd, Pb, and Mn in the atmospheric particles from the Beijing office, Cr, Co, Ni, and As in the atmospheric particles from Xinxiang park, and all nine heavy metal elements in the atmospheric particles from roads in both cities were found to be more concentrated in the coarse fractions; however, Pb, Zn, Cd, Ni, and As in the atmospheric particles from Beijing park, Co, Zn, Ni, Cr, As, and Cu in the atmospheric particles from the Beijing office, Pb, Zn, Cd, Cu, and Mn in the atmospheric particles from Xinxiang park, and all nine metal elements in the atmospheric particles from the Beijing office showed the opposite pattern. The result of a human health risk assessment indicated that the carcinogenic risk of the five carcinogenic elements were all less than 10-4, but a lower potential cancer risk would also occur under long term exposure. For the four non-carcinogenic elements (Pb, Zn, Mn, and Cu), the non-carcinogenic health risk values of Pb, Zn, Mn, and Cu in the atmospheric particulates in Beijing were all far less than 1, which means the corresponding non-carcinogenic risk was negligible; and, except for Mn, there was no obvious non-carcinogenic risk from Pb, Zn, and Cu in the atmospheric particles of Xinxiang.

Reliability and validity of the international dementia alliance schedule for the assessment and staging of care in China.

BACKGROUND: Clinical and social services both are important for dementia care. The International Dementia Alliance (IDEAL) Schedule for the Assessment and Staging of Care was developed to guide clinical and social care for dementia. Our study aimed to assess the validity and reliability of the IDEAL schedule in China. METHODS: Two hundred eighty-two dementia patients and their caregivers were recruited from 15 hospitals in China. Each patient-caregiver dyad was assessed with the IDEAL schedule by a rater and an observer simultaneously. The Clinical Dementia Rating (CDR), Mini-Mental Status Examination (MMSE), and Caregiver Burden Inventory (CBI) were assessed for criterion validity. IDEAL repeated assessment was conducted 7-10 days after the initial interview for 62 dyads. RESULTS: Two hundred seventy-seven patient-caregiver dyads completed the IDEAL assessment. Inter-rater reliability for the total score of the IDEAL schedule was 0.93 (95%CI = 0.92-0.95). The inter-class coefficient for the total score of IDEAL was 0.95 for the interviewers and 0.93 for the silent raters. The IDEAL total score correlated with the global CDR score (ρ = 0.72, p < 0.001), the CDR-sum of box (CDR-SOB, ρ = 0.74, p < 0.001), the total score of MMSE (ρ = -0.65, p < 0.001) and CBI (ρ = 0.70, p < 0.001). All item scores of the IDEAL schedule were associated with the CDR-SOB (ρ = 0.17 ~ 0.79, all p < 0.05). CONCLUSION: The IDEAL schedule is a valid and reliable tool for the staging of care for dementia in the Chinese population.

False-positive diagnosis of disease progression by magnetic resonance imaging for response assessment in prostate cancer with bone metastases: A case report and review of the pitfalls of images in the literature.

Bone metastases are common in prostate cancer. However, differentiating neoplastic from non-neoplastic alterations of bone on images is challenging. In the present report, a rare case of bone marrow reconversion on magnetic resonance imaging (MRI) assessment, which may lead to a false-positive diagnosis of disease progression of bone metastases in hormone-resistant prostate cancer, is presented. Furthermore, a review of the literature regarding the pitfalls of images for response assessment, including the 'flare' phenomenon on bone scintigraphy, computed tomography (CT), positron emission tomography/CT and marrow reconversion on MRI is also provided. These inaccuracies, which may lead to a premature termination of an efficacious treatment, should be carefully considered by the radiologists and oncologists involved in clinical trials. The case reported in the present study showed how to assess the early therapeutic response and select the appropriate treatment for the patient when these pitfalls are encountered on clinical images.