Diagnostic test accuracy of serum creatinine and cystatin C-based index for sarcopenia: a systematic review and meta-analysis.

BACKGROUND: Sarcopenia is an important prognostic factor, but its optimal screening methods remain challenging. Several new indices developed based on serum creatinine (Cr) and cystatin C (CysC) have been proposed to be diagnostic biomarkers for sarcopenia screening. OBJECTIVE: This review aimed to evaluate the diagnostic accuracy of serum Cr- and CysC-based indices for sarcopenia diagnosis. METHODS: We systematically searched MEDLINE, EMBASE, SCIE and SCOPUS from inception to 2 April 2023. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate random-effects model was used to synthesise the pooled sensitivity, specificity and area under the curves of the summary receiver operating characteristic (SROC-AUC). RESULTS: We retrieved 936 publications and included 16 studies with 5,566 participants (mean age ranged: 51.0-78.4 years, 50.2% men). The prevalence of sarcopenia ranged from 7.8 to 69.5%. All included studies presented a moderate to high risk of bias. The serum Cr- and CysC-based indices showed moderate diagnostic accuracy for sarcopenia (pooled sensitivity: 0.67, 95% CI 0.57-0.75; pooled specificity: 076, 95% CI 0.67-0.83; pooled SROC-AUC: 0.78, 95% CI 0.74-0.81). The Cr/CysC ratio is the most widely studied index, followed by the Cr × eGFRcys index. Overall, both indicators had satisfactory and comparable performance in screening sarcopenia. CONCLUSION: Serum Cr- and CysC-based indices showed moderate diagnostic accuracy for sarcopenia. The most studied indices-the Cr/CysC ratio and Cr × eGFRcys index-had comparable diagnostic accuracy for evaluating sarcopenia and may serve as surrogate markers for sarcopenia. However, further validation is required to verify these findings.

ADM-SLAM: Accurate and Fast Dynamic Visual SLAM with Adaptive Feature Point Extraction, Deeplabv3pro, and Multi-View Geometry.

Visual Simultaneous Localization and Mapping (V-SLAM) plays a crucial role in the development of intelligent robotics and autonomous navigation systems. However, it still faces significant challenges in handling highly dynamic environments. The prevalent method currently used for dynamic object recognition in the environment is deep learning. However, models such as Yolov5 and Mask R-CNN require significant computational resources, which limits their potential in real-time applications due to hardware and time constraints. To overcome this limitation, this paper proposes ADM-SLAM, a visual SLAM system designed for dynamic environments that builds upon the ORB-SLAM2. This system integrates efficient adaptive feature point homogenization extraction, lightweight deep learning semantic segmentation based on an improved DeepLabv3, and multi-view geometric segmentation. It optimizes keyframe extraction, segments potential dynamic objects using contextual information with the semantic segmentation network, and detects the motion states of dynamic objects using multi-view geometric methods, thereby eliminating dynamic interference points. The results indicate that ADM-SLAM outperforms ORB-SLAM2 in dynamic environments, especially in high-dynamic scenes, where it achieves up to a 97% reduction in Absolute Trajectory Error (ATE). In various highly dynamic test sequences, ADM-SLAM outperforms DS-SLAM and DynaSLAM in terms of real-time performance and accuracy, proving its excellent adaptability.

Artificial stem cells mediated inflammation-tropic delivery of antiviral drugs for pneumonia treatment.

BACKGROUND: Cytomegalovirus (CMV) pneumonia is a major cause of morbidity and mortality in immunodeficiency individuals, including transplant recipients and Acquired Immune Deficiency Syndrome patients. Antiviral drugs ganciclovir (GCV) and phosphonoformate (PFA) are first-line agents for pneumonia caused by herpesvirus infection. However, the therapy suffers from various limitations such as low efficiency, drug resistance, toxicity, and lack of specificity. METHODS: The antiviral drugs GCV and PFA were loaded into the pH-responsive nanoparticles fabricated by poly(lactic-co-glycolic acid) (PLGA) and 1,2-dioleoyl-3-trimethylammonium-propane (DOTAP), and further coated with cell membranes derived from bone marrow mesenchymal stem cells to form artificial stem cells, namely MPDGP. We evaluated the viral suppression effects of MPDGP in vitro and in vivo. RESULTS: MPDGP showed significant inflammation tropism and efficient suppression of viral replication and virus infection-associated inflammation in the CMV-induced pneumonia model. The synergistic effects of the combination of viral DNA elongation inhibitor GCV and viral DNA polymerase inhibitor PFA on suppressing the inflammation efficiently. CONCLUSION: The present study develops a novel therapeutic intervention using artificial stem cells to deliver antiviral drugs at inflammatory sites, which shows great potential for the targeted treatment of pneumonia. To our best knowledge, we are the first to fabricate this kind of artificial stem cell to deliver antiviral drugs for pneumonia treatment.

Characteristics of amino acid metabolism in preterm infants in Guangxi, China. / å¹¿è¥¿åœ°åŒºæ—©äº§å„¿æ°¨åŸºé ¸ä»£è°¢ç‰¹ç‚¹ç ”ç©¶.

OBJECTIVES: To study the characteristics of amino acid metabolism in preterm infants in Guangxi, China. METHODS: A retrospective analysis was performed on the medical data of 30 757 neonates who underwent the screening for inherited metabolic diseases and had negative results in Guangxi Neonatal Disease Screening Center from 2018 to 2020. Among these neonates, there were 28 611 normal full-term infants (control group) and 2 146 preterm infants (preterm birth group). According to gestational age, the preterm infants were further divided into four groups: very preterm (n=209), moderately preterm (n=307), and late preterm group (n=1 630). According to birth weight, they were divided into three groups: very low birth weight group (n=161), low birth weight group (n=1 085), and normal birth weight group (n=900). According to blood collection time, they were divided into three groups: 3-7 days group (n=1 664), 8-14 days group (n=314) and 15-28 days group (n=168). Tandem mass spectrometry was performed to measure the levels of 11 amino acids in dried blood spots, which were then compared between groups. RESULTS: After adjustment for confounding factors, there were significant differences in the levels of 11 amino acids among different gestational age groups (P<0.05), and significant differences were observed in the levels of the 11 amino acids between the control group and the various preterm groups (except for citrulline and methionine in the late preterm group). There were significant differences in the levels of 11 amino acids among different birth weight groups (P<0.05). Except for ornithine, there were significant differences in the levels of other amino acids among the different blood collection time groups (P<0.05). CONCLUSIONS: Gestational age, birth weight and blood collection time all affect amino acid metabolism in preterm infants in Guangxi, China. This provides a basis for the laboratory to establish the reference standard and clinical interpretation of blood amino acid levels in preterm infants, and to improve the nutritional metabolism of preterm infants.

Joint Angle-Doppler Estimation Algorithm Based on Time Reversal Post-Doppler Adaptive MUSIC in Low-Angle Multipath Environments.

This letter proposes a time-reversal (TR) post-Doppler adaptive multiple signal classification (MUSIC) algorithm for multiple-input multiple-output (MIMO) radars, which addresses the joint estimation of angle and Doppler in diffuse multipath environments. First, an improving TR MIMO multipath model is proposed to avoid the ambiguity between the direction and Doppler in one round trip. Then, the letter designs a spatial filter matrix according to transmit-receive steering matrices, suppressing undesired round trips. Finally, we combine the post-Doppler adaptive MUSIC algorithm and the designed filter to estimate angle and Doppler jointly. Simulation results verify the applicability and effectiveness of the proposed model and algorithm.

Doubly Covariance Matrix Reconstruction Based Blind Beamforming for Coherent Signals.

This paper proposes a beamforming method in the presence of coherent multipath arrivals at the array. The proposed method avoids the prior knowledge or estimation of the directions of arrival (DOAs) of the direct path signal and the multipath signals. The interferences are divided into two groups based on their powers and the interference-plus-noise covariance matrix (INCM) is reconstructed through the doubly covariance matrix reconstruction concept. The composite steering vector (CSV) that accounts for the direct path signal and multipath signals is estimated as the principal eigenvector of the sample covariance matrix with interferences and noise removed. The optimal weight vector is finally computed using the INCM and the CSV. The proposed method involves no spatial smoothing and avoids reduction in the degree of freedom. Simulation results demonstrate the improved performance of the proposed method.

Effect of Sodium Oleate on the Adsorption Morphology and Mechanism of Nanobubbles on the Mica Surface.

Nanobubbles promote the flotation of fine-grained minerals. In the associated mechanism, the aggregation of fine particles is first promoted, which increases the probability of collision between particles and bubbles. However, the interaction between nanobubbles and mineral particles is often neglected, especially when the surface properties of the nanobubbles are modified by flotation collectors. In this study, the interaction mechanism between nanobubbles and the mica surface is investigated by nanoparticle tracking analysis, zeta potential measurement, and atomic force microscopy. The results reveal that the hydrophobic group of sodium oleate points toward the inside of the nanobubble and the hydrophilic group faces outward after the interaction of sodium oleate molecules and nanobubbles. A surfactant micelle with nanobubbles as the core is formed, thus considerably reducing the concentration of sodium oleate to form micelles. The adsorption of the modified nanobubbles on the mineral surface is carried out by the specific adsorption of the exposed hydrophilic group and the mineral surface. This adsorption method is superior to the hydrophobic interaction between the nanobubbles and the hydrophobic mineral surface. Further, the nanobubbles are highly selective for the activation sites on the mineral surface in the adsorption mode. This study will help understand the interaction between nanobubbles and collectors to further apply nanobubbles to treat fine-grained mineral particles.

Short-term outcomes of traction-assisted versus conventional endoscopic submucosal dissection for superficial gastrointestinal neoplasms: a systematic review and meta-analysis of randomized controlled studies.

BACKGROUND: In recent years, some traction-assisted approaches have been introduced to facilitate endoscopic submucosal dissection (ESD) procedures by reducing the procedure time and risks related to the procedure. However, the relative advantages of traction-assisted endoscopic submucosal dissection (T-ESD) are still being debated. This study aimed to assess the efficacy of T-ESD for the treatment of superficial gastrointestinal neoplasms. METHODS: We searched MEDLINE, Embase, and Cochrane library up to March 31, 2019 for randomized controlled trials (RCTs) comparing T-ESD and conventional endoscopic submucosal dissection (C-ESD) for superficial gastrointestinal neoplasms. The main endpoints are en bloc resection, complete resection, procedure time, perforation, and delayed bleeding. Pooled risk ratio (RR), Peto odds ratio (OR), and mean difference (MD) were calculated to compare T-ESD and C-ESD. This study is registered with PROSPERO, number CRD42018108135. RESULTS: A total of 7 RCTs with 1007 patients were included in this meta-analysis. There were no significant differences between the T-ESD and C-ESD groups in the pooled estimate of en bloc resection, complete resection, and delayed bleeding (RR = 1.00, 95% CI 0.99, 1.01, I2 = 0%, P = 0.66; RR = 1.00, 95% CI 0.98, 1.03, I2 = 0%, P = 0.81; OR = 0.95, 95% CI 0.48, 1.86, I2 = 19%, P = 0.87,respectively). The pooled estimate indicated that the procedure time was significantly shorter in the T-ESD group (MD = - 16.19, 95% CI - 29.24, - 3.13, I2 = 87%, P = 0.02) than in the C-ESD group. Compared to C-ESD, T-ESD was associated with lower incidence of perforation (OR = 0.32, 95% CI 0.11, 0.91, I2 = 0%, P = 0.03). CONCLUSIONS: T-ESD is a safe and effective treatment option with a low perforation rate and shorter procedure time than C-ESD for superficial gastrointestinal neoplasms. Future multi-center (including European populations), randomized controlled trials of larger sample size and long-term outcomes of T-ESD are required.

Compressed Sensing Radar Imaging: Fundamentals, Challenges, and Advances.

In recent years, sparsity-driven regularization and compressed sensing (CS)-based radar imaging methods have attracted significant attention. This paper provides an introduction to the fundamental concepts of this area. In addition, we will describe both sparsity-driven regularization and CS-based radar imaging methods, along with other approaches in a unified mathematical framework. This will provide readers with a systematic overview of radar imaging theories and methods from a clear mathematical viewpoint. The methods presented in this paper include the minimum variance unbiased estimation, least squares (LS) estimation, Bayesian maximum a posteriori (MAP) estimation, matched filtering, regularization, and CS reconstruction. The characteristics of these methods and their connections are also analyzed. Sparsity-driven regularization and CS based radar imaging methods represent an active research area; there are still many unsolved or open problems, such as the sampling scheme, computational complexity, sparse representation, influence of clutter, and model error compensation. We will summarize the challenges as well as recent advances related to these issues.

Double-Group Particle Swarm Optimization and Its Application in Remote Sensing Image Segmentation.

Particle Swarm Optimization (PSO) is a well-known meta-heuristic. It has been widely used in both research and engineering fields. However, the original PSO generally suffers from premature convergence, especially in multimodal problems. In this paper, we propose a double-group PSO (DG-PSO) algorithm to improve the performance. DG-PSO uses a double-group based evolution framework. The individuals are divided into two groups: an advantaged group and a disadvantaged group. The advantaged group works according to the original PSO, while two new strategies are developed for the disadvantaged group. The proposed algorithm is firstly evaluated by comparing it with the other five popular PSO variants and two state-of-the-art meta-heuristics on various benchmark functions. The results demonstrate that DG-PSO shows a remarkable performance in terms of accuracy and stability. Then, we apply DG-PSO to multilevel thresholding for remote sensing image segmentation. The results show that the proposed algorithm outperforms five other popular algorithms in meta-heuristic-based multilevel thresholding, which verifies the effectiveness of the proposed algorithm.

Golay Complementary Waveforms in Reed-Müller Sequences for Radar Detection of Nonzero Doppler Targets.

Golay complementary waveforms can, in theory, yield radar returns of high range resolution with essentially zero sidelobes. In practice, when deployed conventionally, while high signal-to-noise ratios can be achieved for static target detection, significant range sidelobes are generated by target returns of nonzero Doppler causing unreliable detection. We consider signal processing techniques using Golay complementary waveforms to improve radar detection performance in scenarios involving multiple nonzero Doppler targets. A signal processing procedure based on an existing, so called, Binomial Design algorithm that alters the transmission order of Golay complementary waveforms and weights the returns is proposed in an attempt to achieve an enhanced illumination performance. The procedure applies one of three proposed waveform transmission ordering algorithms, followed by a pointwise nonlinear processor combining the outputs of the Binomial Design algorithm and one of the ordering algorithms. The computational complexity of the Binomial Design algorithm and the three ordering algorithms are compared, and a statistical analysis of the performance of the pointwise nonlinear processing is given. Estimation of the areas in the Delay-Doppler map occupied by significant range sidelobes for given targets are also discussed. Numerical simulations for the comparison of the performances of the Binomial Design algorithm and the three ordering algorithms are presented for both fixed and randomized target locations. The simulation results demonstrate that the proposed signal processing procedure has a better detection performance in terms of lower sidelobes and higher Doppler resolution in the presence of multiple nonzero Doppler targets compared to existing methods.

Range Sidelobe Suppression Using Complementary Sets in Distributed Multistatic Radar Networks.

We propose an alternative waveform scheme built on mutually-orthogonal complementary sets for a distributed multistatic radar. Our analysis and simulation show a reduced frequency band requirement for signal separation between antennas with centralized signal processing using the same carrier frequency. While the scheme can tolerate fluctuations of carrier frequencies and phases, range sidelobes arise when carrier frequencies between antennas are significantly different.

[Treatment of declining in ovarian reserve by shen-reinforcing and menstrual cycle-regulating therapy combined with western medicine: a clinical observation].

OBJECTIVE: To observe the clinical effect of Shen-reinforcing and menstrual cycle-regulating therapy (SRMCRT) combined with Western medicine (WM) in treating decline in ovarian reserve (DOR). METHODS: Totally 78 patients with DOR were assigned to the traditional Chinese medicine combined WM group (abbreviated as IM group, 40 cases), and the WM group (38 cases) according to random digit table method. Patients in the WM group were treated with hormone replacement therapy, while those in the IM group additionally received SRMCRT. The therapeutic course for all was 3 consecutive months. The therapeutic efficacy was compared between the two groups. The serum levels of follicle stimulating hormone (FSH), FSH/luteinizing hormone (LH), and estradiol (E2), as well as the development of sinus follicles were compared between before and after treatment in the two groups. RESULTS: The therapeutic effective rate was 92.5% in the IM group, higher than that of the WM group (73.68%, P < 0.05). The serum levels of FSH, FSH/LH, and E2 decreased (P < 0.05) and the number of the sinus follicle increased (P < 0.05) in the two groups after treatment. Besides, IM was superior in decreasing serum levels of FSH and FSH/LH, and increasing the number of the sinus follicle (P < 0.05). CONCLUSIONS: SRMCRT was an effective method for treating ROD. IM was superior in decreasing serum levels of FSH and FSH/LH, and increasing the number of the sinus follicle.

Predicting the potential distribution of 12 threatened medicinal plants on the Qinghai-Tibet Plateau, with a maximum entropy model.

Climate change is a vital driver of biodiversity patterns and species distributions, understanding how organisms respond to climate change will shed light on the conservation of endangered species. In this study, the MaxEnt model was used to predict the potential suitable area of 12 threatened medicinal plants in the QTP (Qinghai-Tibet Plateau) under the current and future (2050s, 2070s) three climate scenarios (RCP2.6, RCP4.5, RCP8.5). The results showed that the climatically suitable habitats for the threatened medicinal plants were primarily found in the eastern, southeast, southern, and some parts of the central regions on the QTP. Moreover, 25% of the threatened medicinal plants would have reduced suitable habitat areas within the next 30-50 years in the different future global warming scenarios. Among these medicinal plants, RT (Rheum tanguticum) would miss the most habitat (98.97%), while the RAN (Rhododendron anthopogonoides) would miss the least habitat (10.15%). Nevertheless, 33.3% of the threatened medicinal plants showed an increase in their future habitat area because of their physiological characteristics which are more adaptable to a wide range of climates. The climatic suitable habitat for 50% of the threatened medicinal plants would migrate to higher altitudes or higher latitudes regions. This study provides a data foundation for the conservation of biodiversity and wild medicinal plants on the QTP.

Modeling the effect of grazing on carbon and water use efficiencies in grasslands on the Qinghai-Tibet Plateau.

BACKGROUND: Carbon and water use efficiencies (CUE and WUE, respectively) are vital indicators of the adaptability of plants to environmental conditions. However, the effects of grazing and climate change on the spatiotemporal changes in CUE and WUE in Qinghai-Tibet Plateau grasslands (QTPG) are still unclear. RESULTS: Using the enhanced Biome-BGCMuSo model in combination with observed data, we estimated and analyzed the spatiotemporal variations in CUE and WUE and their responses to grazing in QTPG from 1979 to 2018. The mean annual CUE was 0.7066 in QTPG from 1979 to 2018 under the actual climate scenario. In general, the grassland CUE was low in the southeast and high in the northwest. Grazing generally decreased CUE in QTPG from 1979 to 2018, and there was an increasing trend in the difference in CUE between the grazing and nongrazing scenarios. The difference in CUE was generally greater in the northwest than in the southeast. The mean annual WUE was 0.5591 g C/kg H2O in QTPG from 1979 to 2018 under the actual climate scenario. After 2000, the grassland WUE exhibited a fluctuating upward trend. In general, the grassland WUE was greater in the southeast than in the northwest. Grazing generally decreased WUE in QTPG from 1979 to 2018, and there was an increasing trend in the difference in WUE between the grazing and nongrazing scenarios. The difference in WUE was generally greater in the northwest than in the southeast. CONCLUSIONS: The findings of this study suggested that the spatiotemporal changes in CUE and WUE in QTPG were closely related to changes in the natural environment and grazing management.

Development and Validation of PRE-SARC (PREdiction of SARCopenia Risk in Community Older Adults) Sarcopenia Prediction Model.

OBJECTIVE: Reliable identification of high-risk older adults who are likely to develop sarcopenia is essential to implement targeted preventive measures and follow-up. However, no sarcopenia prediction model is currently available for community use. Our objective was to develop and validate a risk prediction model for calculating the 1-year absolute risk of developing sarcopenia in an aging population. METHODS: One prospective population-based cohort of non-sarcopenic individuals aged 60 years or older were used for the development of a sarcopenia risk prediction model and model validation. Sarcopenia was defined according to the 2019 Asian Working Group for Sarcopenia consensus. Stepwise logistic regression was used to identify risk factors for sarcopenia incidence within a 1-year follow-up. Model performance was evaluated using the area under the receiver operating characteristics curve (AUROC) and calibration plot, respectively. RESULTS: The development cohort included 1042 older adults, among whom 87 participants developed sarcopenia during a 1-year follow-up. The PRE-SARC (PREdiction of SARCopenia Risk in community older adults) model can accurately predict the 1-year risk of sarcopenia by using 7 easily accessible community-based predictors. The PRE-SARC model performed well in predicting sarcopenia, with an AUROC of 87% (95% CI, 0.83-0.90) and good calibration. Internal validation showed minimal optimism, with an adjusted AUROC of 0.85. The prediction score was categorized into 4 risk groups: low (0%-10%), moderate (>10%-20%), high (>20%-40%), and very high (>40%). The PRE-SARC model has been incorporated into an online risk calculator, which is freely accessible for daily clinical applications (https://sarcopeniariskprediction.shinyapps.io/dynnomapp/). CONCLUSIONS: In community-dwelling individuals, the PRE-SARC model can accurately predict 1-year sarcopenia incidence. This model serves as a readily available and free accessible tool to identify older adults at high risk of sarcopenia, thereby facilitating personalized early preventive approaches and optimizing the utilization of health care resources.

[Treatment of premature ovarian failure by bushen huoxue recipe combined estrogen and progesterone: a clinical research].

OBJECTIVE: To observe the clinical efficacy of bushen huoxue recipe (BHR) combined estrogen and progesterone in treating premature ovarian failure (POF), and to explore an effective treatment program of POF by integrative medicine. METHODS: Totally 265 POF patients were randomly assigned to 3 groups, i.e., Group I (86 cases, treated by BHR),Group II (88 cases,treated by conjugated estrogens and medroxyprogesterone acetate), and Group III (91 cases,treated by BHR +conjugated estrogens and medroxyprogesterone acetate). The therapeutic course for each group was 6 months. The main symptoms (including menstrual cycle, hectic fever, night sweat, vaginal dryness, and low libido), laboratory indices [including follicle stimulating hormone (FSH), luteotropic hormone (LH), estradiol (E2), and inhibin B (INH-B)], B-ultrasound indicators (including endometrial thickness, ovarian volume, and antral follicle count), and adverse reactions were observed in the three groups at the end of treatment and 6 months after treatment. RESULTS: Compared with before treatment, the main symptoms, laboratory indices, and B-ultrasound indicators were statistically improved in the three groups at the end of treatment and 6 months after treatment (P <0.05, P <0.01). Better effects were obtained in Group III in improving symptoms of the menstrual cycle, vaginal dryness, and low libido, lowering levels of FSH and LH, elevating levels of E2and INH-B, and ameliorating the endometrial thickness, the ovarian volume, and the antral follicle count (P <0.05, P <0.01). No obvious adverse reaction occurred in the three groups. CONCLUSION: BHR combined estrogen and progesterone showed better clinical efficacy than use of BHR or estrogen/progesterone alone, indicating it was an effective treatment program for POF.

A Novel Locking Buttress Plate Designed for Simultaneous Medial and Posterolateral Tibial Plateau Fractures: Concept and Comparative Finite Element Analysis.

OBJECTIVE: The complex tibial plateau fractures involving both medial and posterolateral columns are of frequent occurrence in clinics, but the existing fixation system cannot deal with medial and posterolateral fragments simultaneously. Therefore, a novel locking buttress plate named as medial and posterior column plate (MPCP) was designed in this study to fix the simultaneous medial and posterolateral tibial plateau fractures. Meanwhile, the comparative finite element analysis (FEA) was conducted to investigate the discrepancy between MPCP and traditional multiple plates (MP + PLP) in their biomechanical characteristics. METHODS: Two 3D finite element models of simultaneous medial and posterolateral tibial plateau fracture fixed with MPCP and MP + PLP system, respectively, was constructed. To imitate the axial stress of knee joint in ordinary life, diverse axial forces with 100, 500, 1000, and 1500 N were applied in the two fixation models, and then the equivalent displacement and stress nephograms and values were obtained. RESULTS: The similar trend of displacement and stress increasing with the loads was observed in the two fixation models. However, several heterogeneities of displacement and stress distribution were found in the two fixation models. The max displacement and von Mises stress values of plates, screws, and fragments in the MPCP fixation model were significantly smaller than that in the MP + PLP fixation model, except for the max-shear stress values. CONCLUSION: As a single locking buttress plate, the MPCP system showed the excellent benefit on improving the stability of the simultaneous medial and posterolateral tibial plateau fractures, compared with the traditional double plate fixation system. However, the excessive shear stress around screw holes should be paid attention to prevent trabecular microfracture and screw loosening.

Role of gender and age in features of Wilson's disease.

Background: Wilson's disease (WD) is a recessive genetic disorder characterized by copper metabolism dysfunction. It is difficult to obtain an accurate diagnosis due to its variable clinical presentation. This study aimed to describe the clinical characteristics and diagnostic particularities in a series of Chinese WD patients. Methods: The medical records of 371 patients with WD retrieved from January 2005 to December 2020 were retrospectively reviewed. Results: The incidence of WD has a male predominance in the adult population. However, the difference in sex distribution is not significant in the pediatric population. Females have an earlier symptom onset than males. The most common initial symptoms were neuropsychiatric manifestations both in the pediatric population (49.7%) and adult population (69.8%), and there was a male predominance (61.8%). Eighty-two percent of patients presented with more than two neurologic symptoms. Fifty-two (14%) patients presented with psychiatric symptoms. The most common WD phenotype was the neuropsychiatric form (48%). The age of onset occurred earlier in patients with the hepatic phenotype than in those with the neuropsychiatric phenotype. Moreover, there was a significant difference in sex distribution regarding phenotype. Females presented with a hepatic phenotype more often than males, and the neuropsychiatric phenotype occurred more frequently in males with an older onset age. Further study showed that the age at onset was a deciding factor for predicting the neuropsychiatric phenotype among the hepatic phenotype. However, sex did not correlate with the phenotype. Conclusion: Males seem to have a higher disease susceptibility, with symptom onset later than females. Males frequently present with a neuropsychiatric phenotype, while females present with a hepatic phenotype. Age at onset was a deciding factor for predicting the WD phenotype. Further studies focusing on the effect of estrogens on the pathology of WD are suggested.

Pain as a risk factor for incident sarcopenia in community-dwelling older adults: A 1-year prospective cohort study.

BACKGROUND: Pain-related muscle disuse and inflammatory reactions may increase the risk of sarcopenia among older adults with pain. Although several studies have examined the association between pain and sarcopenia, the findings are mixed. In the present study, we examined the association of pain as well as pain intensity and location with incident sarcopenia among community-dwelling older adults and explored whether this association differed between men and women. METHODS: Pain characteristics, including the presence of pain, intensity (mild, moderate, and severe), and location (multisite, low back, joint, and chest), were self-reported at baseline. Sarcopenia was identified according to the consensus of the Asin Working Group for Sarcopenia 2019 at baseline and 1 year later. Multivariable Poisson regression was used to determine the association of pain status, intensity, and location with incident sarcopenia, respectively. RESULTS: Eight hundred seventy-three participants (67.1 ± 4.9 years, 524 female) who were free of sarcopenia at baseline were included, of which 64 (7.3%) developed sarcopenia in the follow-up. The presence of pain was significantly associated with an increased risk of incident sarcopenia in older adults (adjusted RR = 1.83, 95% CI = 1.16-2.89), with a significant risk accumulation in incident sarcopenia upon higher pain intensity. Older adults with multisite pain, low back pain, or joint pain were more likely to develop sarcopenia. Although older men reported a lower prevalence and intensity of pain, their risk of sarcopenia during follow-up was generally more pronounced than older women. CONCLUSIONS: Older adults with pain had a significantly higher risk of incident sarcopenia, with a significant risk accumulation in sarcopenia development upon higher pain intensity and specific pain location. Additional attention is needed to identify older adults with pain and to implement timely pain interventions to prevent sarcopenia. High-quality randomized controlled trials are warranted to verify the clinical significance of the present study.