Risk analysis for subsequent fracture of osteoporotic fractures in Chinese women over age 60: a nationwide cross-sectional study.

Prevention of subsequent fracture is a major public health challenge in the field of osteoporosis prevention and treatment, and older women are at high risk for osteoporotic fractures. This study aimed to examine factors associated with subsequent fracture in older Chinese women with osteoporosis. We collected data on 9212 older female patients with osteoporotic fractures from 580 medical institutions in 31 provinces of China. Higher odds of subsequent fractures were associated with age of 70-79 years (OR 1.218, 95% CI 1.049-1.414), age ≥ 80 (OR 1.455, 95% CI 1.222-1.732), index fracture site was vertebrae (OR 1.472, 95% CI 1.194-1.815) and hip (OR 1.286, 95% CI 1.041-1.590), index fracture caused by fall (OR 1.822, 95% CI 1.281-2.591), strain (OR 1.587, 95% CI 1.178-2.139), no inducement (OR 1.541, 95% CI 1.043-2.277), and assessed as high risk of fracture (OR 1.865, 95% CI 1.439-2.416), BMD T-score ≤ -2.5 (OR 1.725, 95% CI 1.440-2.067), history of surgery (OR 3.941, 95% CI 3.475-4.471) and trauma (OR 8.075, 95% CI 6.941-9.395). Low risk of fall (OR 0.681, 95% CI 0.513-0.904), use of anti-osteoporosis medication (AOM, OR 0.801, 95% CI 0.693-0.926), and women who had received fall prevention health education (OR 0.583, 95% CI 0.465-0.730) associated with lower risk. The areas under the curve of the prediction model was 0.818. The sensitivity was 67.0% and the specificity was 82.0%. The prediction model showed a good ability to predict the risk of subsequent fracture in older women with osteoporotic fractures and are suitable for early self-measurement which may benefit post-fracture management.

Effects of electronic sports games on children s acquisition of basic motor skills in a digital society / 中国学校卫生

Objective@#To evaluate the influence of electronic sports games on children s acquisition of basic motor skills, so as to provide assistance for childrens acquisition of basic motor skills in the context of digital society.@*Methods@#Computer searches were conducted on CNKI, Web of Science, Cochrane Library and PubMed databases from March 2012 to March 2022. Methodological quality of included studies was evaluated using the Cochrane bias risk assessment tool RoB 2 and the extension tools RoB 2 Cluster and ROBINS-I. Publication bias assessment, heterogeneity test, subgroup analysis and Meta analysis were performed using RevMan 5.3.@*Results@#A total of 12 studies included 897 participants, 7 randomized controlled trials, 2 cohort randomized controlled trials and 3 non randomized trials. Among them, 2 items had a low risk of bias, 8 items had certain risks and 2 items had a high risk of bias. Measures of basic motor skills in children from 12 studies included object control skills, motor skills, coordination, agility and balance. The results of Meta analysis showed that electronic sports games had a positive effect on children s acquisition of basic motor skills ( SMD=0.81, 95%CI=0.46-1.17, P <0.05).@*Conclusion@#Children can generate positive interactive communication behavior through physical activity and digital screen, and then promote the development of basic motor skills.

An analysis of the associated factors for falls, recurrent falls, and fall-related injuries among the older adults in senior Chinese apartments: A cross-sectional study.

Older adults living in care facilities such as senior apartments may experience falls and severe falls (i.e., fall-related injuries or falls ≥2 times), which are associated with multiple risk factors. However, there are few studies on falls among older adults in senior Chinese apartments. The purpose of our study is to investigate the current situation of falls among older adults in senior apartments and analyze the related factors of falls and severe falls, to assist agency workers in identifying older adults who are at high risk of falls and reducing fall occurrence and fall injuries.

Bio-inspired Oxidative Stress Amplifier for Suppressing Cancer Metastasis and Imaging-Guided Combination Therapy.

Antioxidant-defense systems of tumor cells protect them from oxidative damage and is strongly associated with tumor metastasis. In this work, a mussel-inspired multifunctional nanomedicine (ZS-MB@P) has been designed for inhibiting tumor growth and metastasis through amplified oxidative stress and photothermal/magnetothermal/photodynamic triple-combination therapy. This nanomedicine was fabricated via loading a silica shell on the magnetic nano-octahedrons [zinc-doped magnetic Fe3O4 nano-octahedrons] by encapsulating photosensitizer methylene blue (MB) and subsequently coating polydopamine (PDA) shells as "gatekeeper." The nanomedicine could realize photothermal therapy, photodynamic therapy, and magnetic hyperthermia after treatment with near-infrared (NIR) irradiation and applied magnetic field. Under pH and NIR stimulation, controlled amount of MB was released to produced exogenous reactive oxygen species. Noteworthy, PDA can amplify intracellular oxidative stress by depleting glutathione, thus inhibiting breast cancer metastasis effectively since oxidative stress is an important barrier to tumor metastasis. The outstanding ability to suppress tumor growth and metastasis was comprehensively assessed and validated both in vitro and in vivo. Moreover, the nanomedicine showed outstanding T2 magnetic resonance imaging for tracking the treatment process. Taken together, this work offers an innovative approach in the synergistic treatment of recalcitrant breast cancer.

Corrigendum to "Remodeling tumor immunosuppressive microenvironment via a novel bioactive nanovaccines potentiates the efficacy of cancer immunotherapy" [Bioactive Mater. 16 107-119].

[This corrects the article DOI: 10.1016/j.bioactmat.2022.03.008.].

The dynamic impact of Joint Awareness on Quality of Life after Total Knee Arthroplasty: a longitudinal study.

BACKGROUND: Joint Awareness is thought to be closely linked to Quality of Life (QoL) for patients undergoing Total Knee Arthroplasty (TKA), yet to date there have been no longitudinal studies to explore how Joint Awareness actually affects QoL. The purpose of this study was therefore to examine the development of Joint Awareness and QoL after TKA as well as the dynamic impact of Joint Awareness on QoL. METHODS: A total of 342 patients were followed up at 3 months (T1), 6 months (T2), and 12 months (T3) after TKA. Joint Awareness was evaluated using the Forgotten Joint Score-12 (FJS-12), and QoL was measured by SF-36. We used repeated measures analysis of variance to estimate the development of Joint Awareness and QoL and employed a cross-lagged model to examine the dynamic relationship between Joint Awareness and QoL. RESULTS: Both Joint Awareness and QoL improved with postoperative time (p < 0.001). Importantly, T1 Joint Awareness positively predicted T2 physical QoL (p < 0.001), and T2 Joint Awareness positively predicted T3 physical QoL (p < 0.001). Nevertheless, Joint Awareness had no predictive effect on mental QoL (p = 0.082-0.931). CONCLUSIONS: In different periods after TKA, Joint Awareness and QoL both increased monotonically, and Joint Awareness positively predicted physical QoL. These findings indicate that focusing on Joint Awareness may be a priority when trying to improve the postoperative life of patients.

Sediment nitrogen contents controlled by microbial community in a eutrophic tributary in Three Gorges Reservoir, China.

Nitrogen pollution caused serious environmental problems in reservoir ecosystems. Reducing nitrogen pollution by enhancing nitrogen removal in river sediments deserved intensive research. Distributions of nitrogen contents in sediment-water interface were characterized along the Xiangxi bay (XXB), a eutrophic tributary in Three Gorges Reservoir, China. More than 47% of total Kjeldahl nitrogen (TKN) and 67% of total organic nitrogen (TON) were degraded during burial. Higher TN, TON and NH4+ consuming at downstream sites indicated stronger nitrogen mineralization and release due to higher turbulence of the overlying density currents. Nitrifying bacteria, denitrifying bacteria, anaerobic ammonium oxidizing (anammox) bacteria and nitrite/nitrate-dependent anaerobic methane oxidation (N-DAMO) bacteria were detected in nitrate-ammonium transition zone. Nitrogen contents transitions were responded to microbial stakeholders indicated microbially mediated nitrogen cycling in sediments. The dissolved oxygen and nitrate availabilities were the key limits of denitrification and associated reactions. These results suggested microbial mediated nitrogen cycling processes in sediments were critical for nitrogen removal in aquatic ecosystems, and replenishing dissolved oxygen and nitrate was expected to enhance sediment denitrification and strengthen potential environmental self-purification.

Functions and clinical significance of mechanical tumor microenvironment: cancer cell sensing, mechanobiology and metastasis.

Dynamic and heterogeneous interaction between tumor cells and the surrounding microenvironment fuels the occurrence, progression, invasion, and metastasis of solid tumors. In this process, the tumor microenvironment (TME) fractures cellular and matrix architecture normality through biochemical and mechanical means, abetting tumorigenesis and treatment resistance. Tumor cells sense and respond to the strength, direction, and duration of mechanical cues in the TME by various mechanotransduction pathways. However, far less understood is the comprehensive perspective of the functions and mechanisms of mechanotransduction. Due to the great therapeutic difficulties brought by the mechanical changes in the TME, emerging studies have focused on targeting the adverse mechanical factors in the TME to attenuate disease rather than conventionally targeting tumor cells themselves, which has been proven to be a potential therapeutic approach. In this review, we discussed the origins and roles of mechanical factors in the TME, cell sensing, mechano-biological coupling and signal transduction, in vitro construction of the tumor mechanical microenvironment, applications and clinical significance in the TME.

Bacillus cereus (EG-Q3) in the Gut of Ectropis grisescens Contributes to Host Response to Starvation Conditions.

The gut bacteria of insects play an important role in their nutrition, maintenance, and ecological adaption. Ectropis grisescens is the most important leaf-feeding pest in tea gardens in China. In order to explore whether E. grisescens adaptation under starvation stress is related to its gut bacteria, we used a culture-independent method to compare the composition and diversity of their gut bacteria under starvation treatment. The results revealed no significant changes in core gut bacteria composition and diversity within 24 h of starvation. However, non-core gut bacterial Bacillus increased significantly under starvation conditions. B. cereus strain EG-Q3 isolated from the gut of E. grisescens in carbon source-selected medium showed the ability to degrade fat bodies from E. grisescens in vitro and in vivo. Moreover, the fat-lowering ratio of E. grisescens fed with B. cereus strain EG-Q3 (6.76 ± 1.281%) was significantly higher than that of the control group (3.96 ± 0.801%, t = 4.15, df = 8, p < 0.01) after starvation for 4 h. These findings suggest that non-core gut bacterial B. cereus strain EG-Q3 contributes to host adaptation to starvation. Together, this research provides evidence that E. grisescens may benefit from non-core gut bacteria under starvation conditions.

Remodeling tumor immunosuppressive microenvironment via a novel bioactive nanovaccines potentiates the efficacy of cancer immunotherapy.

The clinical outcomes of cancer nanovaccine have been largely impeded owing to the low antigen-specific T cell response rate and acquired resistance caused by the immunosuppressive tumor microenvironment (TME). Here, we reported a tumor acidity-responsive nanovaccine to remodel the immunosuppressive TME and expand the recruitment of tumor infiltrating lymphocytes (TILs) using hybrid micelles (HM), which encapsulated colony stimulating factor 1 receptor (CSF1-R) inhibitor BLZ-945 and indoleamine 2,3-dioxygenase (IDO) inhibitor NLG-919 in its core and displayed a model antigen ovalbumin (OVA) on its surface (denoted as BN@HM-OVA). The bioactive nanovaccine is coated with a polyethylene glycol (PEG) shell for extending nanoparticle circulation. The shell can be shed in response to the weakly acidic tumor microenvironment. The decrease in size and the increase in positive charge may cause the deep tumor penetration of drugs. We demonstrated that the bioactive nanovaccine dramatically enhance antigen presentation by dendritic cells (DCs) and drugs transportation into M1-like tumor-associated macrophages (TAMs) and tumor cells via size reduction and increasing positive charge caused by the weakly acidic TME. Such bioactive nanovaccine could remodel the immunosuppressive TME into an effector T cells favorable environment, leading to tumor growth inhibition in prophylactic and therapeutic E.G7-OVA tumor models. Furthermore, combining the bioactive nanovaccine with simultaneous anti-PD-1 antibody treatment leads to a long-term tumor inhibition, based on the optimal timing and sequence of PD-1 blockade against T cell receptor. This research provides a new strategy for the development of efficient cancer immunotherapy.

Analysis of the Humoral Immunal Response Transcriptome of Ectropis obliqua Infected by Beauveria bassiana.

Ectropis obliqua is a destructive masticatory pest in China's tea gardens. Beauveria bassiana as microbial insecticides can effectively control E. obliqua larvae; however, the immune response of this insect infected by B. bassiana are largely unknown. Here, after isolating a highly virulent strain of B. bassiana from E. obliqua, the changes in gene expression among different tissues, including hemocytes and fat bodies, of E. obliqua larvae infected by the entomopathogen were investigated using transcriptome sequencing. A total of 5877 co-expressed differentially expressed genes (DEGs) were identified in hemocytes and fat bodies, of which 5826 were up-regulated in hemocytes and 5784 were up-regulated in fat bodies. We identified 249 immunity-related genes, including pattern recognition receptors, immune effectors, signal modulators, and members of immune pathways. A quantitative real-time PCR analysis confirmed that several pattern recognition receptors were upregulated in hemocytes and fat bodies; however, others were downregulated. The investigated immune effectors (ATT and PPO-1) were suppressed. The results showed that there were tissue differences in the expression of immune genes. This study provides a large number of immunity-related gene sequences from E. obliqua after being infected by B. bassiana, furthering the understanding of the molecular mechanisms of E. obliqua defenses against B. bassiana.

Phenol degradation in waters with high iodide level by layered double hydroxide-peroxodisulfate: Pathways and products.

Recently, layered double hydroxide-peroxodisulfate (LDH-PDS) as an advanced oxidation system can effectively remove organics by the pathway of free radical. However, little has been known if there is a potential risk regarding the formation of high toxic iodine byproducts through another pathway when LDH-PDS is used in high iodide waters at coastal areas. Therefore, this study investigated phenol degradation pathways and transformation products to evaluate both removal mechanism and potential risk by LDH-PDS in high iodide waters. The results showed that in LDH-PDS system, with the degradation of PDS, phenol degraded till below detection limit in 1 hr in the presence of iodide, while PDS and phenol were hardly degraded in the absence of iodide, indicating iodide accelerated the transformation of PDS and the degradation of phenol. What is more, it reached the highest phenol removal efficiency under the condition of 100 mg/L LDH, 0.1 mmol/L PDS and 1.0 mmol/L iodide. In LDH-PDS system, iodide was rapidly oxidized by the highly active interlayer PDS, resulting in the formation of reactive iodine including hypoiodic acid, iodine and triiodide instead of free radicals, which contributed rapid degradation of phenol. However, unfortunately toxic iodophenols were detected. Specifically, 2-iodophenol and 4-iodophenol were formed firstly, afterwards 2,4-diiodophenol and 2,6-diiodophenol were produced, and finally iodophenols and diiodophenols gradually decreased and 2,4,6-Triiodophenol were produced. These results indicated that LDH-PDS should avoid to use in high iodide waters to prevent toxic iodine byproduct formation although iodide can accelerate phenol degradation.

Engineered Mesenchymal Stem Cells as a Biotherapy Platform for Targeted Photodynamic Immunotherapy of Breast Cancer.

Interleukin-12 (IL12) is a pleiotropic cytokine with promising prospects for cancer immunotherapy. Though IL12 gene-based therapy can overcome the fatal hurdle of severe systemic toxicity, targeted delivery and tumor-located expression of IL12 gene remain the challenging issues yet to be solved. Photo-immunotherapy emerging as a novel and precise therapeutic strategy, which elaborately combines immune-activating agents with light-triggered photosensitizers for potentiated anticancer efficacy. Herein, an engineered stem cell-based biotherapy platform (MB/IL12-MSCs) incorporating immune gene plasmid IL12 (pIL12) and photosensitizer methylene blue (MB) is developed to realize tumor-homing delivery of therapeutic agents and photo-immunotherapy efficacy enhancement. The biotherapy platform retained tumor-tropic migration and penetration functions, which improved the intratumoral distribution of therapeutic agents, thereby promoting photodynamic effects and reinforcing immune responses. Importantly, MB/IL12-MSCs restricted the expression and distribution of IL12 at tumor site, which minimized potential toxicity while eliciting sufficient anticancer immunity. In noteworthy, activation of immunity induced by MB/IL12-MSCs established long-term systemic immunologic memory to prevent tumor relapse. The MB/IL12-MSCs outperform their monotherapy counterparts in breast tumor models, and the growth of tumor significantly arrested as well as re-challenging abscopal tumor growth slowdown. Collectively, this work reveals that MSCs-based strategy may advance more efficient, durable, and safer cancer photo-immunotherapy.

Low temperature exerts protective effects by inhibiting mitochondria-mediated apoptosis pathway following pressure injury to rat muscle.

OBJECTIVE: We aimed to determine the effect of different low-temperature range interventions at different time-points in a rat model of pressure injury (PI) produced by Ischemia/Reperfusion (I/R) injury. METHODS: Sprague-Dawley rats were randomly assigned to blank control, injury control, and temperature intervention groups. Rats in the injury control and temperature intervention groups (involving exposure to different temperature range at different time-points) were subjected to three cycles of I/R injury with 2-h ischemia and 0.5-h reperfusion to induce PI. RESULTS: The muscle tissues exhibited degenerative changes after compression. Low temperature intervention of 16-18°C in the ischemia period resulted in the lowest degree of tissue damage and significantly decreased levels of Bcl-2-associated X protein (Bax), caspase-9, and caspase-3. Moreover, it resulted in the highest expression level of B-cell lymphoma 2 (Bcl-2) and lowest expression levels of Bax, caspase-9, and caspase-3 in muscle tissues among all intervention groups. CONCLUSION: Low-temperature intervention at 16-18°C during the ischemia period showed optimal effects on the expressions of apoptotic factors during the development of PI with I/R-induced tissue damage.

Multistage-responsive nanovehicle to improve tumor penetration for dual-modality imaging-guided photodynamic-immunotherapy.

The exploration of an intelligent multifunctional imaging-guided therapeutic platform is of great significance because of its ideal delivery efficiency and controlled release. In this work, a tumor microenvironment (TME)-responsive nanocarrier (denoted as MB@MSP) is designed for on-demand, sequentially release of a short D-peptide antagonist of programmed cell death-ligand 1 (named as PDPPA-1) and a photosensitizer methylene blue (MB). Fe3O4-Au located in the core of MB@MSP is used as a magnetic resonance imaging and micro-computed tomography imaging contrast agent for noninvasive diagnosis of solid tumors and simultaneous monitoring of drug delivery. The PDPPA-1 coated on MB@MSP can be shed due to the cleavage of the peptide substrate by matrix metalloproteinase-2 (MMP-2) that is highly expressed in the tumor stroma, and disulfide bonding is further broken when it encounters high levels of glutathione (GSH) in TME, which finally leads to significant size reduction and charge-reversal. These transitions facilitate penetration and uptake of nanocarriers against tumors. Noticeably, the released PDPPA-1 can block the immune checkpoint to create an environment that favors the activation of cytotoxic T lymphocytes and augment the antitumor immune response elicited by photodynamic therapy, thus significantly improving therapeutic outcomes. Studies of the underlying mechanisms suggest that the designed MMP-2 and GSH-sensitive delivery system not only induce apoptosis of tumor cells but also modulate the immunosuppressive tumor microenvironment to eventually augment the suppression tumor metastasis effect of CD8+ cytotoxic T cells. Overall, the visualization of the therapeutic processes with comprehensive information renders MB@MSP an intriguing platform to realize the combined treatment of metastatic tumors.

The Random Forest Model Has the Best Accuracy Among the Four Pressure Ulcer Prediction Models Using Machine Learning Algorithms.

PURPOSE: Build machine learning models for predicting pressure ulcer nursing adverse event, and find an optimal model that predicts the occurrence of pressure ulcer accurately. PATIENTS AND METHODS: Retrospectively enrolled 5814 patients, of which 1673 suffer from pressure ulcer events. Support vector machine (SVM), decision tree (DT), random forest (RF) and artificial neural network (ANN) models were used to construct the pressure ulcer prediction models, respectively. A total of 19 variables are included, and the importance of screening variables is evaluated. Meanwhile, the performance of the prediction models is evaluated and compared. RESULTS: The experimental results show that the four pressure ulcer prediction models all achieve good performance. Also, the AUC values of the four models are all greater than 0.95. Besides, the comparison of the four models indicates that RF model achieves a higher accuracy for the prediction of pressure ulcer. CONCLUSION: This research verifies the feasibility of developing a management system for predicting nursing adverse event based on big data technology and machine learning technology. The random forest and decision tree model are more suitable for constructing a pressure ulcer prediction model. This study provides a reference for future pressure ulcer risk warning based on big data.

A two-week single-group longitudinal test of a new sonic-powered toothbrush simulating the 'bass brushing technique' with tapered bristles on the brush head for reduction of dental plaque and gingivitis.

OBJECTIVE: To investigate the effect of a new powered toothbrush with tapered bristles on the brush head for the reduction of dental plaque and gingivitis. METHODS: This was a single-centre, single-group, longitudinal clinical trial. Thirty-two participants who were typical manual toothbrush users were recruited and assigned the sonic-powered brush. Interviews were arranged on the 1st , 4th , and 15th days which represented the baseline (T1 ), middle (T2 ) and final (T3 ) time points, respectively. At each visit, the plaque index (PlI), gingival index (GI), bleeding on probing (BOP) and probing depth (PD) were recorded for the Ramfjord index teeth, gingival crevicular fluid(GCF) samples were collected and the proportions of eight periodontal pathogenic bacteria were analysed. Repeated-measures analysis of variance (ANOVA) was used for comparisons at different time points. RESULTS: PlI was significantly reduced by 41.67% from T1 to T2 (p<0.001) and decreased by 18.57% from T2 to T3 (p=0.003). GI also varied significantly from T1 to T2 (p=0.018) and T1 to T3 (p=0.037). A 35.86% reduction in the BOP percentage occurred after using the sonic-powered toothbrush for 3 days (p=0.001). However, no significant difference was observed in the mean values of PD at different examination intervals (p=0.529). There was no significant difference in the proportions of bacteria between T1 and T3 (p>0.05). CONCLUSION: This research demonstrated the efficacy of the sonic-powered brush handle together with tapered bristles on the brush in reducing plaque and gingivitis within a short time period.

Fabrication of Ag@Au (core@shell) nanorods as a SERS substrate by the oblique angle deposition process and sputtering technology.

Gold (Au) and silver (Ag) are the main materials exhibiting strong Surface-Enhanced Raman Scattering (SERS) effects. The Ag nano-rods (AgNRs) and Au nano-rods (AuNRs) SERS substrates prepared using the technology of the oblique angle deposition (OAD) process have received considerable attention in recent years because of their rapid preparation process and good repeatability. However, AgNR substrates are unstable due to the low chemical stability of Ag. To overcome these limitations, an Ag@Au core-shell nano-rod (NR) array SERS substrate was fabricated using the OAD process and sputtering technology. Moreover, simulation analysis was performed using finite-difference time-domain calculations to evaluate the enhancement mechanism of the Ag@Au NR array substrate. Based on the simulation results and actual process conditions, the Ag@Au core-shell NR array substrate with the Au shell thickness of 20 nm was studied. To characterize the substrate's SERS performance, 1,2-bis(4-pyridyl)ethylene (BPE) was used as the Raman probe. The limit of detection of BPE could reach 10-12 M. The Ag@Au NR array substrate demonstrated uniformity with an acceptable relative standard deviation. Despite the strong oxidation of the hydrogen peroxide (H2O2) solution, the Ag@Au NR array substrate maintains good chemical stability and SERS performance. And long-term stability of the Ag@Au NR substrate was observed over 8 months of storage time. Our results show the successful preparation of a highly sensitive, repeatable and stable substrate. Furthermore, this substrate proves great potential in the field of biochemical sensing.

Prevalence of Fear of Falling and Its Association With Physical Function and Fall History Among Senior Citizens Living in Rural Areas of China.

Background: Fear of falling (FOF) is as significant as a fall, leading to limited physical activity and poor quality of life among senior citizens. This study aimed to investigate the prevalence of FOF and its association with physical function and fall history among the senior citizens (≥75 years old) living in rural areas of China. Methods: This was a cross-sectional study conducted in eastern China from June to October 2019. All elderly participants were recruited during their attendance for the free health examinations in villages and towns organized by the local healthcare authorities. Data on sociodemographics, fall history, FOF conditions, self-reported comorbidity and regular medications were collected by face-to-face interview, and the physical function status was evaluated through a field test. Univariate and multivariate analyses were performed to compare the differences in physical function and fall history of senior citizens with/without FOF. Results: A total of 753 senior citizens (mean age = 79.04) participated in this study. Of these, 63.5% were aged 75-80. FOF was reported in 22.8% of the participants, while 18.5% had a fall in the past year. Among the senior citizens with and without a fall history, the prevalences of FOF were 38.8 and 19.2%, respectively. On multivariate analyses, FOF was independently associated with the Time Up and Go Test (TUG) duration (OR = 1.080; 95% CI: 1.034-1.128), 4-Stage Balance Test score (OR = 0.746; 95% CI: 0.597-0.931), fall history (OR = 2.633; 95% CI: 1.742-3.980), cerebral apoplexy (OR = 2.478; 95% CI: 1.276-4.813) and comorbidities (≥2) (OR = 1.637; 95% CI: 1.066-2.514), while the correlation between FOF and the 30-s chair stand test was only statistically significant in univariate analysis (Z = -3.528, p < 0.001). Conclusion: High prevalence of FOF is observed among the senior citizens living in rural areas of China. FOF is strongly correlated with physical function performance and fall history. Therefore, the implementation of targeted FOF prevention measures is key to improve the physical activity of the senior citizens, which would ultimately lead to fall prevention and improved quality of life.

Adenovirus diseases: a systematic review and meta-analysis of 228 case reports.

OBJECTIVE: The clinical characteristics of various adenovirus (ADV) infection are underexplored up till now. To investigate the risk factors, manifestation, current status of ADV species, treatment and prognosis of this disease. METHODS: We performed a Pubmed and Embase systematic review for case report reporting the ADV infection to analyze the clinical characteristics of disease. RESULTS: Initial database searched identified articles of which 168 (228 cases) were included in the final analysis. Previous solid organ transplantation [odds ratio (OR) = 3.45, 95% CI 1.31-9.08, P = 0.01], hematopoietic stem cell transplant (OR = 4.24, 95% CI 1.33-13.51, P = 0.01) and hematological malignancy (OR = 4.78, 95% CI 1.70-13.46, P = 0.01) were associated with increased risk of disseminated ADV infection. Use of corticosteroids (OR = 3.86, 95% CI 1.21-12.24, P = 0.02) was a significant risk factor for acquiring urinary tract infections. A total of six species (21 types) of ADV infection have been identified in 100/228 (43.9%) cases. ADV B was the most common species. ADV B species (26/60, 52.0% or 5/41, 12.2% P = 0.001) were more isolated in patients with ADV pneumonia. ADV C (13/15, 86.7% versus 35/86, 40.7% P = 0.001) species were more identified in patients with disseminated disease. The species associated with keratoconjunctivitis is only ADV D in our analysis. Urinary tract ADV infections were observed in ADV A/B/D species. Cidofovir (CDV) (82/228, 36.0%) remained the most commonly antiviral therapy in our cases, followed by ribavirin (15/228, 6.6%), ganciclovir (18/228, 7.9%), and brincidofovir (12/228, 5.3%). Brincidofovir was administered as salvage therapy in 10 cases. Death was reported in 81/228 (35.5%) patients. Mortality rate was higher among patients with gastrointestinal (GI) ADV infection (5/10, 50.0%), ADV pneumonia (20/45, 44.4%) and disseminated ADV infection (53/122, 43.4%). CONCLUSION: Previous solid organ transplantation, hematopoietic stem cell transplant and hematological malignancy were risk factors for disseminated ADV infection. Use of corticosteroids was significant for urinary tract ADV infection. Different species correlated with different clinical manifestations of infection. Mortality rate was higher among patients with GI disease, pneumonia and disseminated disease. Our review clarified the current treatment of ADV infections, and more treatment required further investigation.