Toxoplasma gondii seropositivity and cognitive functioning in older adults: an analysis of cross-sectional data of the National Health and Nutrition Examination Survey 2011-2014.

OBJECTIVES: This study sought to examine the relationship between Toxoplasma gondii seropositivity and cognitive function in older adults. DESIGN: An observational cross-sectional study. SETTING: The National Health and Nutrition Examination Survey (NHANES) study took place at participants' homes and mobile examination centres. PARTICIPANTS: A total of 2956 older adults aged 60 and above from the NHANES from 2011 to 2014 were included in the study. Exposure of interest: participants had serum Toxoplasma gondii antibody analysed in the laboratory. A value>33 IU/mL was categorised as seropositive for Toxoplasma gondii infection; <27 IU/mL was categorised as seronegative for Toxoplasma gondii infection. PRIMARY AND SECONDARY OUTCOME MEASURES: Cognitive tests included the Consortium to Establish a Registry for Alzheimer's Disease Word Learning subtest (CERAD-WL) for immediate and delayed memory, the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). RESULTS: About half of the 2956 participants (mean age 70.0) were female (51.0%), non-Hispanic White (48.3%), and completed some college or above (48.3%). A total of 703 participants were positive for Toxoplasma gondii infection (23.8%). Adjusted linear regression showed that compared with participants with negative Toxoplasma gondii infection, those with positive Toxoplasma gondii infection had lower CERAD-WL immediate memory (beta (ß) -0.16, 95% CI -0.25 to -0.07), CERAD-WL delayed memory (ß -0.15, 95% CI -0.24 to -0.06), AFT (ß -0.15, 95% CI -0.24 to -0.06), DSST (ß -0.34, 95% CI -0.43 to -0.26), and global cognition (ß -0.24, 95% CI -0.32 to -0.16) z-scores after controlling for the covariates. CONCLUSIONS: Toxoplasma gondii seropositivity is associated with worse immediate and delayed verbal learning, language proficiency, executive functioning, processing speed, sustained attention, working memory, as well as global cognition in older adults. Public health measures aiming at preventing Toxoplasma gondii infection may help preserve cognitive functioning in older adults.

Urinary tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and cognitive functioning in older adults: The National Health and Nutrition Examination Survey 2013-2014.

INTRODUCTION: Tobacco contains carcinogens called tobacco-specific nitrosamines. Among the tobacco-specific nitrosamines, is nicotine-derived nitrosamine ketone (NNK) which produces the metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL). We aimed to examine the association between urinary tobacco-specific NNAL and cognitive functioning among older adults. METHODS: A total of 1673 older adults aged ≥60 years from the National Health and Nutrition Examination Survey 2013-2014 were included. Urinary tobacco-specific NNAL was analyzed in the laboratory. Cognitive functioning was measured using the Consortium to Establish a Registry for Alzheimer's Disease Word Learning subtest (CERAD-WL) immediate and delayed memory tests, the Animal Fluency test (AFT), and the Digit Symbol Substitution Test (DSST). Test-specific and global cognition z-scores were calculated based on means and standard deviations of the cognitive test scores. Multivariable linear regression models were constructed to examine the independent association between quartiles of urinary tobacco-specific NNAL and cognitive test-specific and global cognition z-scores controlling for age, sex, race/ethnicity, education level, depressive symptoms, body mass index, systolic blood pressure, urinary creatinine, hypertension, diabetes, alcohol use, and smoking status. RESULTS: About half of the participants (mean age 69.8 years) were female (52.1%), non-Hispanic White (48.3%), and completed some college and above (49.7%). Multivariable linear regression results showed that participants in the 4th quartile (highest quartile) of urinary NNAL, compared with those in the 1st quartile (lowest quartile), had lower DSST z-scores (ß= -0.19; 95% CI: -0.34 - -0.04). CONCLUSIONS: Tobacco-specific NNAL was negatively associated with processing speed, sustained attention, and working memory in older adults.

GCN5L1-mediated TFAM acetylation at K76 participates in mitochondrial biogenesis in acute kidney injury.

BACKGROUND: Mitochondrial dysfunction is an important pathogenic event in acute kidney injury (AKI). GCN5L1 is a specific acetyltransferase in mitochondria, which regulates glucose and fatty acid metabolism. However, the role of GCN5L1 in mitochondrial dysfunction and the pathogenesis of ischemic AKI are not fully understood. METHODS: The protein level of GCN5L1 was detected by western blot assay. Acetylated proteomics was used to explore the level of acetylated TFAM. Duolink proximity ligation assay and co-immunoprecipitation were used to detect the interaction of TFAM and translocase of outer membrane 70 (TOM70). mtDNA copy number, the expression of mitochondrial electron transport chain complexes, the number and morphology of mitochondria were measured. The renal injury of AKI mice was reflected by the levels of creatinine and urea nitrogen and the pathological changes of renal tissue. RESULTS: We showed that GCN5L1 was highly expressed in vivo and in vitro and renal tubules specific knockdown of GCN5L1 could effectively attenuate AKI-induced mitochondrial impairment. Besides, acetylated proteomics revealed that acetylated TFAM was significantly upregulated in AKI mice kidney, which reminded us that TFAM might be an acetylating substrate of GCN5L1. Mechanistically, we evidenced that GCN5L1 could acetylate TFAM at its K76 site and subsequently inhibited its binding to TOM70, thereby reducing TFAM import into mitochondria and mitochondrial biogenesis. Clinically, GCN5L1 and acetylated TFAM were positively correlated with disease severity (all p < 0.05). CONCLUSIONS: In sum, these data demonstrated an unrecognized regulating mechanism of GCN5L1 on TFAM acetylation and its intracellular trafficking, and a potential intervening target for AKI associated mitochondrial disorders as well.

Secondhand smoke is positively associated with pre-frailty and frailty in non-smoking older adults.

Introduction: Either exposure to secondhand smoke (SHS) or frailty has been linked to adverse health outcomes in nonsmoking adults. However, their relationship is rarely studied. The purpose of this study is to examine the association between serum cotinine level and frailty status among non-smoking older adults. Method: The study population consisted of 2,703 older adults aged ≥60 from the National Health and Nutrition Examination Survey 2011-2014. Non-smokers were included based on (1) a serum cotinine level ≤ 10 ng/mL and 2) a response of "no" to the question, "Do you currently smoke?" Frailty status was measured based on the Fried Phenotype and had three groups- robust, pre-frailty, and frailty. Multinomial logistic regression models were constructed to examine the association between serum cotinine level quartile and frailty status, controlling for age, sex, race/ethnicity, education, depressive symptoms, alcohol use, and systolic blood pressure. Results: About half of the participants (median age 70.0 years, range 64-78) were female (53.6%), non-Hispanic White (48.3%), and completed some college and above (50.1%). Multinomial logistic regression with a reference group being those in the 1st quantile (the lowest) of serum cotinine level showed that participants in the 4th quartile (the highest) of serum cotinine level had increased odds of pre-frailty vs. robust (OR 1.522, 95% confidence interval [CI] 1.060, 2.185, P = 0.023) as well as increased odds of frailty vs. robust (OR 2.349, 95% CI 1.081, 5.107, P = 0.031). Conclusions: Higher serum cotinine level is associated with increased risk of pre-frailty and frailty versus robust in non-smoking older adults. Prevention and reduction of SHS in older adults may help protect them from developing pre-frailty or frailty.

Heterogeneous Ni3S2@FeNi2S4@NF nanosheet arrays directly used as high efficiency bifunctional electrocatalyst for water decomposition.

Developing and designing bifunctional electrocatalysts are very important for the production of hydrogen from water electrolysis. The reasonable interface modulation can effectively lead to the optimization of electronic configuration through the interface electron transfer in the heterostructures and thus resulting in the enhanced efficiency. In this work, self-supported and heterogeneous interface-rich Ni3S2@FeNi2S4@NF electrocatalyst for overall water splitting was designed and prepared through a controllable step-wise hydrothermal process. Density functional theory calculations suggest that heterogeneous interface formed between Ni3S2 and FeNi2S4 can optimize the Gibbs free energy for H* adsorption (ΔGH*). Benefiting from the open structure of the nanosheet arrays, the abundant heterogeneous interfaces in Ni3S2@FeNi2S4@NF composite, the positive synergistic effect between Ni3S2 and FeNi2S4, and the good conductivity of foamed nickel (NF) substrate, the optimized Ni3S2@FeNi2S4@NF nanoarray catalyst displayed excellent electrocatalytic activities, the overpotential is only 83 mV and 235 mV for hydrogen evolution reaction (HER) and oxygen evolution reaction (OER) at 10 mA cm-2, respectively. Importantly, an alkaline electrolyser directly using the Ni3S2@FeNi2S4@NF as both the anode and cathode achieved an ultralow cell voltage of 1.46 V, accompanied by outstanding stability. The performance is better than that of most other transition-metal sulfides electrocatalysts. This work may provide a useful strategy for reasonably regulating heterogeneous interfaces to effectively improve the performance of materials, thus accelerating the practical application of transition-metal sulfides electrocatalysts for overall water splitting.

Middle lobe preservation and fixation after right upper and lower lobectomy for synchronous lung cancer.

The incidence of multiple lung cancer has been steadily increasing worldwide. Although cases of patients with lung cancers in the right upper and lower lobe have also become more frequently reported in clinical work, simultaneous right upper and lower lobectomy reports with the middle lobe preservation are still quite rare. A total of three patients with lung cancers in the right upper and lower lobe were included in the study. The patients underwent simultaneous right upper and lower lobectomy, whereas the remaining middle lobe was sutured and fixed to the intercostal muscle of the incision to prevent postoperative lobe torsion. There was no procedure to reduce residual space，such as phrenic nerve crush or thoracoplasty. All patients were discharged from the hospital 7 days after the operation. The chest tube was removed 5 days after the operation in two patients. One patient was discharged with the tube because of slight pulmonary leakage, and the tube was removed 2 weeks after the operation. Six months after the operation, the chest computer tomography showed that the middle lobe expanded well and no obvious cavity or pleural effusion was found. The suture of the remaining middle lobe and intercostal muscle of the incision is a simple and effective method that can be used to successfully avoid middle lobe torsion. This strategy is safe and can be used as the first choice for eligible patients.

A prospective randomized controlled study of auricular point acupressure to manage chronic low back pain in older adults: study protocol.

BACKGROUND: Chronic low back pain (cLBP) is a major health problem and the most common pain condition among those aged 60 years or older in the US. Despite the development of pharmacological and nonpharmacological interventions, cLBP outcomes have not improved and disability rates continue to rise. This study aims to test auricular point acupressure (APA) as a non-invasive, nonpharmacological self-management strategy to manage cLBP and to address current shortcomings of cLBP treatment. METHODS/DESIGN: For this prospective randomized controlled study, participants will be randomly assigned to three groups: (1) APA group (active points related to cLBP), (2) Comparison group-1 (non-active points, unrelated to cLBP), and (3) Comparison group-2 (enhanced educational control, an educational booklet on cLBP will be given and the treatment used by participants for their cLBP will be recorded). The ecological momentary assessment smartphone app will be used to collect real-time cLBP outcomes and adherence to APA practice. Treatment and nonspecific psychological placebo effects will be measured via questionnaires for all participants. This proposed trial will evaluate the APA sustained effects for cLBP at 12-month follow-up. Monthly telephone follow-up will be used to collect study outcomes. Blood will be collected during study visits at baseline, post APA treatment, and follow-up study visits at 1, 3, 6, 9 and 12 months post completion of treatment for a total of seven assessments. Appointments will start between 9 and 11 am to control for circadian variation in cytokine levels. DISCUSSION: This study is expected to provide vital information on the efficacy, sustainability, and underlying mechanism of APA on cLBP necessary for APA to gain acceptance from both healthcare providers and patients, which would provide a strong impetus for including APA as part of cLBP management in clinical and home settings. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03589703. Registered on 22 May 2018.

Napping in Older Adults: A Review of Current Literature.

PURPOSE OF REVIEW: Daytime napping-frequently reported among older populations-has attracted increasing attention in geriatric research due to its association with multiple health conditions. This review aims to integrate the latest knowledge about napping in older adults to provide implications for future research. RECENT FINDINGS: The prevalence of napping in older adults ranges from 20% to 60% in different studies, but has been consistently reported to be higher than in other age groups. Age-related changes in circadian rhythm and sleep patterns, cultural beliefs, chronic conditions, medications, and lifestyle changes contribute to the high prevalence of napping in older adults. Daytime napping has been associated with multiple health conditions in older adults. Naps of short duration (e.g., 30 minutes) are reported in adults with better health; naps with longer durations (e.g., >90 minutes) have been linked to adverse cardiovascular and diabetes outcomes, declining cognitive function, and increased mortality. Current evidence in the literature, however, is not enough for us to determine the exact role of napping in the health of older adults. SUMMARY: Longitudinal and interventional studies are needed to investigate the influence of napping and the critical parameters such as duration, timing, and frequency on health in older adults and the underlying mechanisms. A combination of objective and self-reported measurements of napping are recommended instead of self-reported data only.

[Diagnostic value of interleukin-27 in tuberculous pleural effusion].

OBJECTIVE: To explore the diagnostic value of interleukin-27 (IL-27) in tuberculous pleural effusion. METHODS: A total of 76 patients of pleural effusion treated at Shandong Provincial Hospital from March 2013 to February 2014 in accordance with the natures of effusion fluid were divided into: (1) Tuberculosis group of tuberculous pleural effusion (n = 40), including 22 males and 18 females; aged 19 to 73 years; (2) Malignant group of malignant pleural effusion (n = 36), including 20 males and 16 females; aged 33 to 78 years old; including lung cancer (n = 28), lymphoma (n = 3), esophageal (n = 1) and uncertain primary tumor site (n = 4). The effusion and serum levels of IL-27 were detected by enzyme-linked immunosorbent assay (ELISA) and the results analyzed. And the curve of receiver operating characteristic (ROC) was employed to determine the diagnostic value of IL-27 in tuberculous pleural effusion. RESULTS: The level of IL-27 was (1 402 ± 321) ng/L in tuberculous pleural effusion and it was significantly higher than those in malignant pleural effusion (556 ± 133) ng/L and sera (499 ± 88) ng/L (both P < 0.05). According to the ROC curve, the cut-off value of IL-27 was 838 ng/L in diagnosing tuberculous pleural effusion. And the rates of diagnostic sensitivity, specificity and accuracy of IL-27 were 95.0%, 97.2% and 96.1% respectively. CONCLUSIONS: Detection of pleural effusion IL-27 concentration is of great importance in the diagnosis of tuberculous pleural effusion. And it is worthy of wider clinical promotion.

[Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in paratracheal mediastinal lesions].

OBJECTIVE: To explore the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in diagnosing mediastinal lesions. METHODS: A total of 264 patients with mediastinal lesions on chest CT at Provincial Hospital Affiliated to Shandong University between January 2010 and April 2012 were retrospectively enrolled. Their cytopathological results were difficult to be assessed by conventional bronchoscopy. There were 222 cases whose lymph nodes long axis was >1.5 cm. Among them, 174 cases underwent TBNA alone (group A) and the other 48 cases EBUS-TBNA alone (group B). The remaining 42 cases whose lymph nodes long axis was <1.5 cm belonged to group C and underwent TBNA (group C1) and EBUS-TBNA (group C2) sequentially as a combined procedure. The associations of pathologic examinations, diagnostic positive rate and complications were analyzed. RESULTS: Among 174 cases in group A, 154 cases were diagnosed with a positive diagnostic rate of 88.5%. There were 135 malignant lesions while 19 cases were diagnosed with benign diseases and 5 cases had accidental vascular injury. Among 48 cases in group B, 45 cases were diagnosed with a positive diagnostic rate of 93.8%. There were 33 malignant lesions while 12 cases were diagnosed with benign diseases. Among 42 patients in group C1, 31 cases were diagnosed by TBNA with a positive diagnostic rate of 73.8%. There were 23 malignant lesions while 8 cases were diagnosed with benign diseases and 2 cases had accidental vascular injury. Among 42 patients in group C2, 39 cases were diagnosed with a positive diagnostic rate of 92.8%. There were 30 malignant lesions while 9 cases had benign diseases. No difference existed in diagnostic positive rate between groups A and B (χ(2) = 0.621, P = 0.431) while the diagnostic positive rate in group A was much higher than group C1 (χ(2) = 5.945, P = 0.015). The difference between groups B and C2 was insignificant (χ(2) = 0.065, P = 0.320) while there was significant difference between groups C1 and C2 (χ(2) = 5.486, P = 0.019). CONCLUSION: With a low complication rate, EBUS-TBNA can yield a higher diagnostic positive rate in diagnosing small mediastinal diseases than conventional TBNA.

[The diagnostic value of medical thoracoscopy for unexplained pleural effusion].

OBJECTIVE: To explore the endoscopic features of patients with unexplained pleural effusion, and to evaluate the diagnostic value of medical thoracoscopy. METHODS: A retrospective analysis of 2380 patients with unexplained pleural effusion (1320 males and 1060 females; age 15-94 years) in Shandong Provincial Hospital from 1992 to 2011 were performed .The diagnosis was confirmed by medical thoracoscopy. RESULTS: The endoscopic findings of malignant pleural effusion mostly showed nodules of varying sizes. The nodules could be grape-like, cauliflower-like, fused into masses, or diffused small nodules . The appearance of cancerous nodules was more diversified compared to tuberculous nodules. Tuberculous pleurisy was manifested as diffuse pleural congestion and miliary changes, multiple small gray-white nodules, fibrin deposition and adhesion in the pleural cavity, pleural thickening and loculation . The pathological diagnosis was as follows: pleural metastases in 899 (37.8%), primary pleural mesothelioma in 439 (18.4%), tuberculous pleurisy in 514 (21.6%), non-specific inflammation in 226 (9.5%), empyema in 190 (8.0%), hepatic pleural effusion in 36 (1.5%) and pleural effusion of unknown causes in 76 (3.2%) cases. The diagnostic positive rate of medical thoracoscopy was 96.8%. No serious complications were observed. CONCLUSION: Medical thoracoscopy is a relatively safe procedure and has an important application value in the diagnosis of unexplained pleural effusion.

Expression of Yes-associated protein in non-small cell lung cancer and its relationship with clinical pathological factors.

BACKGROUND: Yes-associated protein (YAP) plays an important role in signal transduction and gene transcription regulation in normal cells, with elevated and over-expressed YAP levels observed in various malignant tumors. The aim of this study was to investigate the expression of YAP in non-small cell lung cancer (NSCLC), and to study the possible relationship of YAP expression with the occurrence and development of NSCLC. METHODS: YAP expression was assessed in 40 cases of NSCLC tumor tissues by immunohistochemistry, and their protein and mRNA levels were evaluated through Western blotting and reverse transcription-polymerase chain reaction (PCR), respectively. Normal lung tissues obtained from the same patient were used as control. Statistical analysis was performed to correlate the YAP expression to clinical pathological factors, such as tumor type, stage and grade. RESULTS: YAP-positive expression was found in 28 (70%) of the 40 cases of NSCLC, which included 10 cases of squamous cell carcinoma (25%), 17 cases of adenocarcinoma (42.5%) and 1 case of squamous adenocarcinoma (2.5%). In the 28 YAP-positive cases, 19 cases showed lymph node metastasis and were classified in TNM stage II + III (47.5%); the other nine cases showed no lymph node metastasis (22.5%) and were classified in the TNM stage I. There was no relationship between YAP expression and patients' age, gender or tumor histological grades. However, YAP showed significant over expression in late period of T stage (P = 0.012), TNM stage (P = 0.039), and lymph node metastasis (P = 0.013), respectively. Notably, YAP-positive expression was significantly higher in adenocarcinoma than that in squamous cell carcinoma (P = 0.041). CONCLUSIONS: Over-expression of YAP was associated with NSCLC, especially lung adenocarcinoma. The high YAP expression in late period of tumor stage and lymph node metastasis may indicate that YAP expression could be an early marker for NSCLC tumorigenesis.