Trajectories of depressive symptom and its association with air pollution: evidence from the Mr. OS and Ms. OS Hong Kong cohort study.

BACKGROUND: Depression is a global health priority. Maintaining and delaying depressive symptoms in older adults is a key to healthy aging. This study aimed to identify depressive symptom trajectories, predictors and mortality, while also exploring the relationship between air quality and depressive symptoms in older adults in the Hong Kong community over 14 years. METHODS: This study is a longitudinal study in Hong Kong. The target population was community-dwelling older adults over age 65. Depressive symptoms were measured by the Geriatric Depression Scale (GDS-15). Group-based trajectory model was used to identify heterogeneity in longitudinal changes over 14 years and examine the associations between baseline variables and trajectories for different cohort members using multinomial logistic regression. The Kaplan-Meier method was employed to conduct survival analysis and explore the variations in survival probabilities over time among different trajectory group. Linear mixed model was used to explore the relationship between air quality and depressive symptoms. RESULTS: A total of 2828 older adults were included. Three different trajectories of depressive symptoms in older people were identified: relatively stable (15.4%), late increase (67.1%) and increase (17.5%). Female, more number of chronic diseases, poor cognitive function, and poor health-related quality of life (HRQOL) were significantly associated with other less favorable trajectories compared with participants with stable levels of depressive symptoms. The late increase group had a lower mortality rate than the relatively stable and increased groups. Lower baseline ambient air pollutant exposure to NO2 over 14 years was significantly associated with fewer depressive symptoms. CONCLUSIONS: In this study, we found that a late increase in depressive symptoms was the predominant trend in older Chinese people in Hong Kong. Poorer HRQOL was predictive of less favorable trajectories of depressive symptoms. Ambient air pollution was associated with depressive symptoms. This novel observation strengthens the epidemiological evidence of longitudinal changes in depressive symptoms and associations with late-life exposure to air pollution.

Electroencephalographic interbrain synchronization in children with disabilities, their parents, and neurologic music therapists.

As with typically developing children, children with cerebral palsy and autism spectrum disorder develop important socio-emotional rapport with their parents and healthcare providers. However, the neural mechanisms underlying these relationships have been less studied. By simultaneously measuring the brain activity of multiple individuals, interbrain synchronization could serve as a neurophysiological marker of social-emotional responses. Music evokes emotional and physiological responses and enhances social cohesion. These characteristics of music have fostered its deployment as a therapeutic medium in clinical settings. Therefore, this study investigated two aspects of interbrain synchronization, namely, its phase and directionality, in child-parent (CP) and child-therapist (CT) dyads during music and storytelling sessions (as a comparison). A total of 17 participants (seven cerebral palsy or autism spectrum disorder children [aged 12-18 years], their parents, and three neurologic music therapists) completed this study, comprising seven CP and seven CT dyads. Each music therapist worked with two or three children. We found that session type, dyadic relationship, frequency band, and brain region were significantly related to the degree of interbrain synchronization and its directionality. Particularly, music sessions and CP dyads were associated with higher interbrain synchronization and stronger directionality. Delta (.5-4 Hz) range showed the highest phase locking value in both CP and CT dyads in frontal brain regions. It appears that synchronization is directed predominantly from parent to child, that is, parents and music therapists' brain activity tended to influence a child's. Our findings encourage further research into neural synchrony in children with disabilities, especially in musical contexts, and its implications for social and emotional development.

Positional MR imaging of normal and injured knees.

OBJECTIVES: This study uses a practical positional MRI protocol to evaluate tibiofemoral translation and rotation in normal and injured knees. METHODS: Following ethics approval, positional knee MRI of both knees was performed at 35° flexion, extension, and hyperextension in 34 normal subjects (mean age 31.1 ± 10 years) and 51 knee injury patients (mean age 36.4 ± 11.5 years, ACL tear n = 23, non-ACL injury n = 28). At each position, tibiofemoral translation and rotation were measured. RESULTS: Normal knees showed 8.1 ± 3.3° external tibial rotation (i.e., compatible with physiological screw home mechanism) in hyperextension. The unaffected knee of ACL tear patients showed increased tibial anterior translation laterally (p = 0.005) and decreased external rotation (p = 0.002) in hyperextension compared to normal knees. ACL-tear knees had increased tibial anterior translation laterally (p < 0.001) and decreased external rotation (p < 0.001) compared to normal knees. Applying normal thresholds, fifteen (65%) of 23 ACL knees had excessive tibial anterior translation laterally while 17 (74%) had limited external rotation. None (0%) of 28 non-ACL-injured knees had excessive tibial anterior translation laterally while 13 (46%) had limited external rotation. Multidirectional malalignment was much more common in ACL-tear knees. CONCLUSIONS: Positional MRI shows (a) physiological tibiofemoral movement in normal knees, (b) aberrant tibiofemoral alignment in the unaffected knee of ACL tear patients, and (c) a high frequency of abnormal tibiofemoral malalignment in injured knees which was more frequent, more pronounced, more multidirectional, and of a different pattern in ACL-tear knees than non-ACL-injured knees. KEY POINTS: • Positional MRI shows physiological tibiofemoral translation and rotation in normal knees. • Positional MRI shows a different pattern of tibiofemoral alignment in the unaffected knee of ACL tear patients compared to normal control knees. • Positional MRI shows a high prevalence of abnormal tibiofemoral alignment in injured knees, which is more frequent and pronounced in ACL-tear knees than in ACL-intact injured knees.

A comparison of radiographic degeneration features of older Chinese women and older Italian Caucasian women with a focus on thoracic spine.

BACKGROUND: Compared with Caucasians, East Asians have a lower incident of back pain, lower prevalence and severity of osteoporotic vertebral fracture and lumbar spine degeneration. AIM: This study compares radiographic spine degeneration features of older Chinese women (as an example of East Asians) and older Italian women (as an example of Caucasians) with a focus on the thoracic spine. METHODS: From two population-based epidemiological studies conducted in Hong Kong, China and Rome, Italy, 297 pairs (mean age: 73.6 years) age-matched older community women's lateral spine radiographs were sampled. Existence (or absence) of seven degeneration features were assessed including: (1) hyper-kyphosis, (2) disc space narrowing (T3/T4 ~ T11/T12), (3) osteoarthritic (OA) wedging (T4 ~ T12), (4) generalised osteophyte formation (T4 ~ T12); (5) acquired short vertebrae (T4 ~ T12), (6) Schmorl node (T4 - L5), (7) disc calcification (T4-L5). RESULTS: Italian women were more likely to have hyper-kyphosis (53.4% vs 25.6%), disc space narrowing (34.4% vs. 17.2%), OA wedging (6.4% vs. 0.67%), Schmorl node (19.5% vs. 4.4%, all P < 0.001). However, there was no statistically significant difference in osteophyte formation (7.7% vs. 9.4%, P > 0.1) and acquired short vertebrae (8.0% vs. 10.4%, P > 0.1). Disc calcification was uncommon among both Chinese and Italians. DISCUSSION AND CONCLUSION: For the first time, this study documented a lower prevalence of a number of thoracic spine degeneration features among Chinese. This study further affirms the concept of a generally healthier spine in older Chinese relative to older Caucasians. The observed differences may reflect a foundational background influence of genetic predisposition that represents an important line of future research.

Increased vertebral body area, disc and facet joint degeneration throughout the lumbar spine in patients with lumbosacral transitional vertebrae.

OBJECTIVES: Lumbosacral transitional vertebrae (LSTV), developmental spinal canal stenosis, lumbar disc and facet joint degeneration are all common lumbar spine conditions. This study explores the relationship between these entities. METHODS: Five hundred and five patients (254 females, 251 males), mean age 57 ± 13 years, who underwent abdominopelvic CT examinations were studied. Vertebral body cross-sectional area (CSA), spinal canal CSA, width and depth were measured from L1 to L5. The presence of LSTV was documented and the severity of disc/facet joint degeneration graded. RESULTS: LSTV was present in 155 (31%) of 505 patients, being twice as common in males than in females. After controlling for age, height and weight, vertebral body CSAs from L1 to L5 in male LSTV patients were, on average, 9.8% larger than those in male non-LSTV patients (p < 0.0001 for all) while vertebral body areas at L3 and L4 were 4.5% larger in female LSTV patients than in non-LSTV female patients. Disc degeneration from L2/3 to L5/S1 and facet joint degeneration from L2/3 to L4/5 were more severe in LSTV patients. LSTV Castellvi Type II patients appear to be most prone to disc and facet degeneration. CONCLUSIONS: LSTV patients, and particularly male patients, have an increased vertebral body CSA compared to non-LSTV patients throughout the lumbar spine. LSTV patients also have more severe disc and facet joint degeneration. The increase in vertebral body area may be contributing to the increased lumbar and facet joint degeneration seen in LSTV patients. KEY POINTS: • LSTV patients have increased vertebral body cross-sectional area throughout their lumbar spine compared to non-LSTV patients. This vertebral body area increase was more pronounced in male patients and also apparent in younger patients with LSTV. • LSTV patients have increased disc and facet joint degeneration affecting most of the lumbar spine than non-LSTV patients. • Increased vertebral body area may contribute to the increased lumbar disc and facet joint degeneration seen in LSTV patients.

The effect of subjective social status on health-related quality of life decline in urban Chinese older adults: a four-year longitudinal study from Hong Kong.

BACKGROUND: Improving health-related quality of life (HRQOL) is becoming a major focus of old age care and social policy. Researchers have been increasingly examining subjective social status (SSS), one's self-perceived social position, as a predictor of various health conditions. SSS encompasses not only concrete socio-economic (SES) factors but also intangible aspects of status. This study's main objective was to examine the association between SSS and long-term change in HRQOL in older Chinese adults. METHODS: A longitudinal Hong Kong study recruited 2934 community-dwelling adults (age > 65 years). Participants completed SF-12 physical health (PCS) and mental health (MCS) HRQOL scales. This study analyzed baseline SSS-Society (self-perceived social status within Hong Kong) and SSS-Community (self-perceived status within one's own social network) as predictors of long-term HRQOL decline. After stratifying for sex, multiple-linear-regression was performed on 4-year follow-up SF-12 PCS and MCS scores after adjusting for baseline SF-12 scores, traditional SES indicators, demographic variables, clinical conditions, and lifestyle variables. RESULTS: In the multivariable analyses, lower SSS-Society was associated with declines in MCS in males (ßstandardized = 0.08, p = 0.001) and declines in PCS (ßstandardized = 0.07, p = 0.006) and MCS (ßstandardized = 0.12, p < 0.001) in females. SSS-Community was associated with declines in PCS in males (ßstandardized = 0.07, p = 0.005) and MCS in females (ßstandardized = 0.14, p < 0.001). CONCLUSIONS: SSS may be a useful supplementary tool for predicting risk of long-term HRQOL decline in older Chinese adults. Strategies to reduce perceived social inequalities may improve HRQOL in older adults.

Longitudinal association of built environment pattern with DXA-derived body fat in elderly Hong Kong Chinese: a latent profile analysis.

BACKGROUND: One major limitation of prior studies regarding the associations between built environment (BE) and obesity has been the use of anthropometric indices (e.g., body mass index [BMI]) for assessing obesity status, and there has been limited evidence of associations between BE and body fat. This study aimed to explore the longitudinal association between BE and body fat in a cohort of elderly Hong Kong Chinese and examine whether the BE-body fat associations differed by BMI categories. METHODS: Between 2001 and 2003, 3944 participants aged 65-98 years were recruited and followed for a mean of 6.4 years. BE characteristics were assessed via Geographic Information System. Body fat (%) at whole body and regional areas (trunk, limbs, android, and gynoid) were assessed by dual energy X-ray absorptiometry at baseline and three follow-ups. Latent profile analysis was used to derive BE class, and linear mixed-effects models were used to investigate the associations of BE class with changes in body fat. Stratified analyses by BMI categories were also conducted. RESULTS: Three BE classes were identified. Participants in Class 2 (characterized by greater open space and proportion of residential land use) had a slower increase in whole body fat (B = -0.403, 95% confidence interval [CI]: -0.780, -0.014) and limbs fat (-0.471, 95% CI: -0.870, -0.071) compared with participants in Class 1 (characterized by high proportion of commercial land use). There were significant interactions of BE class with BMI, and participants in Class 2 had a slower increase in whole body fat and regional fat compared with participants in Class 1 (B ranging from -0.987 [limbs] to -0.523 [gynoid]) among overweight and obese participants only. CONCLUSIONS: We found that those who resided in the areas characterized by greater open space and proportion of residential land use had a slower body fat increase.

Eating Behaviors and Diet Quality in Chinese Preschoolers with and without Autism Spectrum Disorder: A Case-Control Study.

OBJECTIVES: To compare mealtime behaviors and diet quality in Chinese preschoolers with autism spectrum disorder (ASD) and typically developing preschoolers in Hong Kong. STUDY DESIGN: This case-control study included a community sample of 65 families with preschoolers with ASD aged 3-6 years and 65 families with typically developing preschoolers matched for age and sex. Preschoolers' eating behaviors were assessed using the Brief Autism Mealtime Behaviour Inventory and the Preschoolers' Eating Behaviour Questionnaire (CPEBQ). Preschoolers' usual diet and nutrient intake were assessed using a validated food frequency questionnaire. Diet quality and diversity were generated using the Chinese Children Dietary Index total score and diet variety score. Between-group differences in various scales and dietary variables were examined using multivariate linear or logistics regression models adjusting for baseline demographic differences. RESULTS: Compared with the typically developing group, the ASD group had greater scores in the Brief Autism Mealtime Behaviour Inventory food refusal domain (P < .001), the CPEBQ food fussiness (P = .001) and eating habit (P = .001) domains, and lower CPEBQ exogenous eating score (P = .003) and initiative eating score (P < .001). The Chinese Children Dietary Index total score (P = .001) and diet variety score (P = .005) and intake of soy and soy products (P = .001) were lower in the ASD group compared with the typically developing group. CONCLUSIONS: Preschoolers with ASD showed more eating and mealtime problems, and lower diet quality and diversity than their typically developing counterparts. Our findings highlight the need for regular monitor and early identification of mealtime behavioral and nutrition problems among preschoolers with ASD.

Fracture Incidence and the Relevance of Dietary and Lifestyle Factors Differ in the United Kingdom and Hong Kong: An International Comparison of Longitudinal Cohort Study Data.

Geographic variation in fracture risk may be due to divergent profiles of dietary, lifestyle, and other risk factors between populations. We investigated differences in fracture rates between two older-population cohorts: the European Prospective Investigation into Cancer and Nutrition (EPIC) Norfolk cohort (n = 7732) in the United Kingdom (UK), and the Mr and Ms Os cohort (n = 3956) in Hong Kong (HK). Data were collected by questionnaires, laboratory assessments, and hospital records. Incidence of hip, spine, and wrist fractures in the two cohorts was calculated and multivariable regression was used to explore variables important to fracture risk. Total hip, spine, and wrist fracture incidence was higher in the UK vs HK for women (13.70 vs 8.76 per 1000 person-years; p < 0.001), but not men (5.95 vs 5.37 per 1000 person-years; p = 0.337), and the proportions of different fractures also varied between cohorts (p < 0.001). Hip fracture was the most common UK fracture (accounting for 56.8% fractures in men and 52.6% in women), while wrist fracture was most common in HK (42.9% in men and 57.9% in women). The major contributor to total fracture risk in multivariable regression models of both cohorts and sexes, was age; with BMI also an important contributor to fracture risk HK men and UK women. The distribution of factors relevant to fracture risk, and the rates of different fractures, varied significantly between UK and HK cohorts. However, the importance of each factor in contributing to fracture risk was similar between the cohorts. The differences in fracture rates suggest targeted approaches may be required when developing interventions and public health recommendations to reduce the burden of osteoporosis in these two countries.

Does Low Subjective Social Status Predict Cognitive Decline in Chinese Older Adults? A 4-Year Longitudinal Study From Hong Kong.

OBJECTIVE: Subjective social status (SSS), one's self-perceived social position, encompasses not only concrete socio-economic (SES) factors (e.g., income) but also intangible aspects of status (e.g., social capital). In recent years, there has been increasing research interest in SSS as a predictor of a vast array of health outcomes but very few studies examining effects on cognitive functioning. This study's main objective was to examine the association between SSS and long-term cognitive decline in older Chinese adults. DESIGN: A 4-year longitudinal study. SETTING: Hong Kong, China. PARTICIPANTS: Chinese adults (aged ≥65) (n = 3,153). MEASUREMENTS: This study analyzed baseline SSS-Hong Kong (self-perceived social status within Hong Kong) and SSS-Community (self-perceived status within one's own social network) as predictors of long-term cognitive decline. Multiple-linear-regression was performed on 4-year follow-up Mini-Mental-Status-Examination (MMSE) cognitive function score (score range: 0-30) after adjusting for baseline MMSE scores, traditional SES indicators (e.g., education), demographic variables (e.g., sex), clinical conditions (e.g., stroke history, depression), and lifestyle variables (e.g., physical activity levels). RESULTS: Lower SSS-Community but not SSS-Hong Kong was associated with greater cognitive decline (unstandardized coefficient (95% CI) = 0.13 (0.07, 0.19) standardized ß-coefficient = 0.08, after adjusting for objective SES measures and other background and clinical factors. The standardized ß-coefficients for the SSS-Community variable were similar in magnitude to those for depression and diabetes. CONCLUSION: Cognitive decline is influenced by self-perceived rank in proximal reference groups rather than socioeconomic comparison with society at-large. SSS-Community is a useful, single-item supplementary instrument to improve prediction of cognitive decline in elderly Chinese.

Spatial correspondence of spinal cord white matter tracts using diffusion tensor imaging, fibre tractography, and atlas-based segmentation.

PURPOSE: Neuroimaging provides great utility in complex spinal surgeries, particularly when anatomical geometry is distorted by pathology (tumour, degeneration, etc.). Spinal cord MRI diffusion tractography can be used to generate streamlines; however, it is unclear how well they correspond with white matter tract locations along the cord microstructure. The goal of this work was to evaluate the spatial correspondence of DTI tractography with anatomical MRI in healthy anatomy (where anatomical locations can be well defined in T1-weighted images). METHODS: Ten healthy volunteers were scanned on a 3T system. T1-weighted (1 × 1 × 1 mm) and diffusion-weighted images (EPI readout, 2 × 2 × 2 mm, 30 gradient directions) were acquired and subsequently registered (Spinal Cord Toolbox (SCT)). Atlas-based (SCT) anatomic label maps of the left and right lateral corticospinal tracts were identified for each vertebral region (C2-C6) from T1 images. Tractography streamlines were generated with a customized approach, enabling seeding of specific spinal tract regions corresponding to individual vertebral levels. Spatial correspondence of generated fibre streamlines with anatomic tract segmentations was compared in unseeded regions of interest (ROIs). RESULTS: Spatial correspondence of the lateral corticospinal tract streamlines was good over a single vertebral ROI (Dice's similarity coefficient (DSC) = 0.75 ± 0.08, Hausdorff distance = 1.08 ± 0.17 mm). Over larger ROI, fair agreement between tractography and anatomical labels was achieved (two levels: DSC = 0.67 ± 0.13, three levels: DSC = 0.52 ± 0.19). CONCLUSION: DTI tractography produced good spatial correspondence with anatomic white matter tracts, superior to the agreement between multiple manual tract segmentations (DSC ~ 0.5). This supports further development of spinal cord tractography for computer-assisted neurosurgery.

Association of green space with bone mineral density change and incident fracture in elderly Hong Kong Chinese: Mr. OS and Ms. OS study.

BACKGROUND: A large body of literature has reported positive effects of green space (GS) on various aspects of health and well-being, while no studies explore the role of GS in bone health. OBJECTIVES: The present study aimed to investigate the associations of GS with bone mineral density (BMD) change and incident fracture in a prospective cohort of elderly Hong Kong Chinese. METHODS: Between 2001 and 2003, 3944 participants aged 65 years and older at baseline were recruited. GS (%) within 300-m and 500-m buffers were calculated for each participant based on the Normalized Difference Vegetation Index. BMD at whole body, lumbar spine, total hip, and femoral neck were assessed by dual energy X-ray absorptiometry at baseline and 3 follow-ups. Incident fracture cases were ascertained from the electronic database of Hospital Authority of Hong Kong. Linear mixed-effects models and Cox proportional hazards models were used to investigate the associations of GS with changes in BMD and incident fracture, respectively. RESULTS: Greater GS within 300-m and 500-m buffers were associated with a slower increase in lumbar spine BMD over 14 years. After adjustment for potential confounders, ß and 95% confidence intervals (CIs) of change in BMD across Q2-Q4 (quartiles of GS measured in a 300-m, compared with Q1) were -6.42 (-12.3, -0.59), -7.78 (-13.6, -1.97), and -7.83 (-13.7, -2.00) mg/cm3, respectively. GS was also positively associated with non-spinal fracture and major osteoporotic fracture incidence risks. Multivariable-adjusted hazard ratios (95%CIs) were 1.40 (1.09, 1.79; P-trend = 0.036) for non-spinal fracture and 1.53 (1.13, 2.07; P-trend = 0.010) for major osteoporotic fracture (Q4 compared with Q1 of GS measured in a 300-m buffer). Positive GS-fracture associations were also found for GS within a 500-m buffer. CONCLUSIONS: We found that those who lived near higher GS levels had a slower increase in lumbar spine BMD and had higher incident fracture risk.

Socioeconomic status as an effect modifier of the association between built environment and mortality in elderly Hong Kong Chinese: A latent profile analysis.

BACKGROUND: Previous studies have focused on associations between individual built environment (BE) characteristics and mortality, and found the BE-mortality associations differed by socioeconomic status (SES). Different individual BE characteristics may have different impacts on health and thus could interact. Combinations of BE characteristics may be a better approach to explore the BE-mortality associations. OBJECTIVES: This study aimed to investigate the associations of BE pattern with mortality in a prospective cohort of elderly Hong Kong Chinese (Mr. OS and Ms. OS Study), and assess whether the BE-mortality association differed by SES. METHODS: Between 2001 and 2003, 3944 participants aged 65-98 years at baseline were included in the present analysis. BE characteristics were assessed via Geographic Information System. Data on all-cause and cause-specific mortality were obtained from the Hong Kong Government Death Registry. Latent profile analysis was used to derive BE class, and the Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Three BE classes were identified. During a total of 53276 person-years of follow-up, 1632 deaths were observed. There were no significant associations of BE class with all-cause and cause-specific mortality. However, we found the associations of BE class with all-cause mortality were modified by SES. In comparison with Class 3 (characterized by greater green space), HRs (95%CIs) were 0.72 (0.54, 0.97) for Class 1 (characterized by greater commercial land use) and 0.77 (0.64, 0.94) for Class 2 (characterized by greater residential land use) among low-SES participants. The associations were stronger among high-SES participants, with 0.55 (0.33, 0.89) for Class 1 and 0.68 (0.48, 0.97) for Class 2. In contrast, Class 2 (HR 1.18, 95%CI 1.01-1.39) had a higher mortality risk compared with Class 3 among middle-SES participants. CONCLUSIONS: Our findings provide new evidence on the role of SES as an effect modifier of BE pattern and mortality. BE pattern has a varied effect on mortality risk for different SES groups.

Urinary sodium excretion and dietary sources of sodium intake in community-dwelling Chinese adults aged 50 years and over.

OBJECTIVE: This study examined Na intake and identified the major food sources of Na in healthy Chinese adults aged ≥50 years in Hong Kong. DESIGN: Participants who completed a baseline assessment of a randomised controlled trial assessing the effectiveness of exercise and nutrition supplementation on improving physical and cognitive functions were included. A single 24-h urine sample and a 3-d diet record were used to measure urinary Na excretion and dietary intake, respectively. The compliances to the WHO (<5 g/d) and China Nutrition Society (<6 g/d) recommendations for salt intake were assessed based on the urinary Na excretion. The relative contribution of sixteen food groups to the dietary Na intake was expressed as percentages. Associations between food groups and urinary Na excretion were analysed using multiple linear regression. SETTING: Community facilities. PARTICIPANTS: Totally, 114 healthy Chinese adults (mean age 60·6 years, 55 % women). RESULTS: The mean urinary Na excretion over 24-h was 2876·6 ± 1249·4 mg/d (7·3 ± 3·2 g salt/d). Overall, 22·8 % of participants met the WHO recommendation and 34·2 % met the Chinese Nutrition Society recommendation for salt intake. The major food sources of dietary Na intake were condiments (42·4 %), cereals and their products (16·8 %) and soups (13·5 %). Higher intakes of seafood and nuts were associated with lower urinary Na excretion. CONCLUSIONS: Public health strategies should target healthy Chinese adults in Hong Kong to modify the current patterns of Na intake. Targeting condiments, cereals and their products and soups will be an important strategy to reduce their Na intake.

MRI wrist in early rheumatoid arthritis: reduction in inflammation assessed quantitatively during treatment period correlates best with clinical improvement.

OBJECTIVE: To investigate (a) which MR features of inflammation (synovitis, tenosynovitis, perfusion) correlate with clinical/serological features in early rheumatoid arthritis (ERA) before, during and after 1 year of treatment and (b) whether quantitative or semi-quantitative measures of inflammation on magnetic resonance imaging (MRI) provides the highest correlation in this regard. METHOD: One hundred one ERA patients (76 females, 25 males, mean age, 53 ± 12 years) underwent clinical/serological testing and 3 T dynamic contrast-enhanced MRI of the most symptomatic wrist. Seventy-seven of the 101 patients completed 1 year of treatment, followed by repeat MR examination. Clinical/serological parameters were correlated with semi-quantitative/quantitative MR measures of inflammation at baseline, during and after 1 year of treatment. Spearman's correlation was applied. RESULTS: Quantitative measures of inflammation correlated better with clinical/serological parameters than semi-quantitative measures, with the highest correlations being for relative change during treatment. Pain reduction correlated with reduced tenosynovitis volume (r = 0.41). Reduction in disease activity correlated with reduction in synovitis volume (r = 0.66) or synovial perfusion parameters (r = 0.58). Decrease in early morning stiffness correlated with decrease in perfusion parameters (r = 0.46). Reduction in ESR and CRP correlated with decrease in synovial volume (r = 0.40 and r = 0.41, respectively). CONCLUSION: In ERA patients, quantitative assessment of inflammation on MRI correlated better with clinical parameters than semi-quantitative assessment. Relative change during treatment yielded the highest correlation. Decrease in tenosynovitis correlated best with reduction in pain while decrease in synovitis volume and perfusion correlated best with reduction in disease activity, early morning stiffness (perfusion), or serological parameters (synovitis volume).

Pain phenotypes classified by machine learning using electroencephalography features.

Pain is a multidimensional experience mediated by distributed neural networks in the brain. To study this phenomenon, EEGs were collected from 20 subjects with chronic lumbar radiculopathy, 20 age and gender matched healthy subjects, and 17 subjects with chronic lumbar pain scheduled to receive an implanted spinal cord stimulator. Analysis of power spectral density, coherence, and phase-amplitude coupling using conventional statistics showed that there were no significant differences between the radiculopathy and control groups after correcting for multiple comparisons. However, analysis of transient spectral events showed that there were differences between these two groups in terms of the number, power, and frequency-span of events in a low gamma band. Finally, we trained a binary support vector machine to classify radiculopathy versus healthy subjects, as well as a 3-way classifier for subjects in the 3 groups. Both classifiers performed significantly better than chance, indicating that EEG features contain relevant information pertaining to sensory states, and may be used to help distinguish between pain states when other clinical signs are inconclusive.

The Predictive Value of Sarcopenia and Falls for 2-Year Major Osteoporotic Fractures in Community-Dwelling Older Adults.

To evaluate the associations of sarcopenia and previous falls with 2-year major osteoporotic fractures (MOFs) in community-dwelling older adults. Four thousand Chinese men and women ≥ 65 years recruited from Hong Kong communities were prospectively followed up. Measures of muscle mass, grip strength, gait speed and falls in the previous year were recorded at baseline, the 2nd year and the 4th year visit for each subject. The associations of fall history, sarcopenia and its components with 2-year MOFs were evaluated using generalized linear mixed models. Poor grip strength and poor gait speed were significantly associated with a higher 2-year MOFs risk, with an adjusted OR (95% CI) per one SD decrease of 1.48 (1.17, 1.87) and 1.17 (1.00, 1.36), respectively. Falls in the previous year was a significant predictor for 2-year MOFs risk, with an adjusted OR (95% CI) per one added fall of 1.85 (1.40, 2.44) in men and 1.26 (1.01, 1.58) in women. The adjusted OR (95% CI) of height adjusted appendicular lean muscle mass (ALM/height2) per one SD decrease and sarcopenia for 2-year MOFs risk were 1.34 (0.87, 2.06) and 1.72 (0.92, 3.21) in men, and were 0.73 (0.57, 0.93) and 0.76 (0.39, 1.47) in women, respectively (P for interaction by gender = 0.012 and 0.017, respectively). Poor sarcopenia-related physical performance and falls in the previous year were significant predictors for 2-year MOFs in community-dwelling older adults. The predictive value of ALM by DXA for near-term fracture risk is limited and different across genders.

Accuracy of ultrasound in the characterisation of deep soft tissue masses: a prospective study.

PURPOSE: To investigate the accuracy of ultrasound in characterising the type of mass and likelihood of malignancy in deep soft tissue masses. METHODS: Five hundred seventy-nine deep soft tissue masses were prospectively studied by ultrasound. Masses (n = 137) with prior MRI or CT were not included. Following ultrasound examination, the likely nature of the mass as well as the confidence of the reporting radiologist ('fully confident' versus 'not fully confident') about the ultrasound diagnosis was recorded. Clinical and ultrasound diagnoses were compared with the histological diagnosis which was available in 134 (23%) of the 579 masses. RESULTS: Compared with histology, clinical and ultrasound accuracy for characterising the type of mass were 47% and 88% respectively when all differential diagnoses were considered. The radiologist was fully confident regarding the type of 436 (75%) of 579 masses and, in this setting, for those cases that could be compared with histology, diagnostic accuracy was 96%. For the remaining masses, where the radiologist was not fully confident, accuracy compared with histology was 58% for the first differential diagnosis and 80% for all differential diagnoses. For identifying malignancy, sensitivity, specificity, and positive and negative predictive value of ultrasound were 97%, 58%, 67%, and 99% respectively. Ultrasound alone was considered sufficient for diagnostic workup in over half of all deep soft tissue masses. CONCLUSION: Ultrasound is useful at characterising and recognising malignancy in deep soft tissue masses. Provided local practice patterns are favourable, ultrasound may be considered a first-line investigation in the diagnostic workup of deep soft tissue masses. KEY POINTS: • In three-quarters of cases, one can be fully confident about characterising the nature of deep soft tissue masses on ultrasound and, for those fully confident cases that could be compared with histology, the diagnostic accuracy of ultrasound was 96%. • Ultrasound can correctly recognise nearly all malignant deep soft tissue masses but some benign masses will also be considered possibly malignant. • Ultrasound alone was considered sufficient for imaging workup in over half of deep soft tissue masses.

Dietary patterns and telomere length in community-dwelling Chinese older men and women: a cross-sectional analysis.

PURPOSE: Environmental and lifestyle factors that affect oxidative stress and inflammation may influence telomere length (TL). There are limited data to relate dietary patterns with TL. This study examined the association of various dietary patterns with TL in Chinese older adults. METHODS: We conducted a cross-sectional analysis and performed multivariate linear regression analyses using available data from 1981 (965 men, 1016 women) community-dwelling Chinese adults aged 65 years and over in Hong Kong. The interviewer administered questionnaires that covered dietary intake estimation and dietary pattern generation from the food frequency questionnaire, demographic and lifestyle factors, and self-reported medical history. TL was measured by quantitative real-time polymerase chain reaction. RESULTS: None of the dietary pattern scores including the Diet Quality Index-International (DQI-I) score, the Dietary Approaches to Stop Hypertension (DASH) score, the Mediterranean-DASH Intervention for Neurodegenerative Delay Diet (MIND) score, the Mediterranean Diet Score (MDS), the Okinawan diet score, as well as the "vegetables-fruits" pattern score, the "snacks-drinks-milk" pattern score, and the "meat-fish" pattern score were associated with TL in the age- and sex-adjusted model and the multivariate adjusted model. CONCLUSION: Our findings suggest a minimal role of dietary patterns in telomere length in community-dwelling Chinese older adults.

The effect of physical activity on dose-relationship between serum 25-hydroxyvitamin D and cardiovascular health events in older adults.

BACKGROUND AND AIMS: Reverse J- or U-shaped associations between serum 25-hydroxyvitamin D (25[OH]D) concentrations and cardiovascular outcomes have been reported, which need clarifications in older adults. Physical activity, correlating with both serum 25[OH]D concentration and cardiovascular health, may have an effect on the dose-relationships. METHODS AND RESULTS: At baseline, 2790 participants aged 65 years and over, free of vitamin D supplementation use, had assays for serum 25[OH]D concentrations and health related characteristics and measurements, were followed up for cardiovascular events and death by up to 7 and 15 years, respectively. The dose-response associations of serum 25[OH]D concentrations with cardiovascular events and mortality risk were examined using Cox regression models. After adjusting for physical activity and other covariates, serum 25[OH]D concentration was non-linearly associated with cardiovascular mortality risk (U-shaped, P = 0.009). According to the Institute of Medicine categories, the HR(95% CI) of cardiovascular mortality risk separately in deficient (<25 nmol/L), inadequate (25 to < 50 nmol/L) and potentially harmful (≥125 nmol/L) level was 1.67 (0.23, 12.01), 1.66 (1.25, 2.20) and 2.21 (0.30, 16.37), respectively. The risk of 25[OH]D inadequacy for cardiovascular mortality was significantly attenuated by increased physical activity, especially leisure activity (P for trend = 0.008 and 0.021, respectively). No significant finding was observed for incident cardiovascular events. CONCLUSION: Both lower and higher serum 25[OH]D concentrations were associated with risk of cardiovascular mortality in Chinese community-dwelling older adults. Physical activity may attenuate the cardiovascular mortality risk of vitamin D inadequacy, but its role in individuals with higher 25[OH]D concentrations remains unclear.