Fully Sparse Fusion for 3D Object Detection.

Currently prevalent multi-modal 3D detection methods rely on dense detectors that usually use dense Bird's-Eye-View (BEV) feature maps. However, the cost of such BEV feature maps is quadratic to the detection range, making it not scalable for long-range detection. Recently, LiDAR-only fully sparse architecture has been gaining attention for its high efficiency in long-range perception. In this paper, we study how to develop a multi-modal fully sparse detector. Specifically, our proposed detector integrates the well-studied 2D instance segmentation into the LiDAR side, which is parallel to the 3D instance segmentation part in the LiDAR-only baseline. The proposed instance-based fusion framework maintains full sparsity while overcoming the constraints associated with the LiDAR-only fully sparse detector. Our framework showcases state-of-the-art performance on the widely used nuScenes dataset, Waymo Open Dataset, and the long-range Argoverse 2 dataset. Notably, the inference speed of our proposed method under the long-range perception setting is 2.7× faster than that of other state-of-the-art multimodal 3D detection methods. Code is released at https://github.com/BraveGroup/FullySparseFusion.

The Southern European Atlantic diet and all-cause and cause-specific mortality: a European multicohort study.

AIMS: The Southern European Atlantic diet (SEAD) is the traditional dietary pattern of northwestern Spain and northern Portugal, but it may resemble that of central, eastern, and western European countries. The SEAD has been found associated with lower risk of myocardial infarction and mortality in older adults, but it is uncertain whether this association also exists in other European populations and if it is similar as that found in its countries of origin. METHODS AND RESULTS: We conducted a prospective analysis of four cohorts with 35 917 subjects aged 18-96 years: ENRICA (Spain), HAPIEE (Czechia and Poland), and Whitehall II (United Kingdom). The SEAD comprised fresh fish, cod, red meat and pork products, dairy, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and moderate wine consumption. Associations were adjusted for sociodemographic variables, energy intake, lifestyle, and morbidity. After a median follow-up of 13.6 years (range = 0-15), we recorded 4 973 all-cause, 1 581 cardiovascular, and 1 814 cancer deaths. Higher adherence to the SEAD was associated with lower mortality in the pooled sample. Fully adjusted hazard ratios and 95% confidence interval per 1-standard deviation increment in the SEAD were 0.92 (0.89, 0.95), 0.91 (0.86, 0.96), and 0.94 (0.89, 0.99) for all-cause, cardiovascular, and cancer mortality, respectively. The association of the SEAD with all-cause mortality was not significantly different between countries [Spain = 0.93 (0.88, 0.99), Czechia = 0.94 (0.89,0.99), Poland = 0.89 (0.85, 0.93), United Kingdom = 0.98 (0.89, 1.07); P for interaction = 0.16]. CONCLUSION: The SEAD was associated with lower all-cause, cardiovascular, and cancer mortality in southern, central, eastern, and western European populations. Associations were of similar magnitude as those found for existing healthy dietary patterns.

In this study of 35 917 subjects from southern, central, eastern, and western European countries, the Southern European Atlantic diet (traditional dietary pattern of northwestern Spain and northern Portugal) was associated with lower 13.6-year mortality from any cause, cardiovascular disease, and cancer. The associations of the Southern European Atlantic diet with lower mortality were not significantly different between countries (Spain, Czechia, Poland, and the United Kingdom). Study associations were similar as those found for existing healthy dietary patterns, suggesting that rather different diets could confer comparable benefits on health.

Mediating role of systemic inflammation in the association between heavy metals exposure and periodontitis risk.

BACKGROUND: This study evaluated the mediating role of systemic inflammation in the association between exposure to heavy metals and periodontitis in a nationwide sample of adults. METHODS: Pooled cross-sectional data from the National Health and Nutrition Examination Survey (NHANES 2009-2014) were used (n = 8993). Periodontitis was defined by a full-mouth examination and classified as no/mild and moderate/severe (mod/sev) groups. Blood and urinary heavy metal levels were investigated, including cadmium (Cd), lead (Pb), and mercury (Hg). In addition, systemic inflammation was assessed using circulatory leukocyte counts and C-reactive protein (CRP) levels. RESULTS: Multivariable logistic regression analysis revealed the positive associations of blood and urinary levels of Cd and Pb with mod/sev periodontitis. In contrast,blood Hg levels did not show a significant association. The odds of having periodontitis were 1.233 and 1.311 times higher for each one-unit increment in Ln-transformed blood Cd (95% confidence interval [CI]: 1.109-1.371) and Pb (95% CI: 1.170-1.470), respectively. Mediation analysis suggested a 6.3% to 11.5% contribution of leucocyte counts in the association of blood Cd and Pb levels with periodontitis. Sensitivity analyses for urinary Cd levels yielded consistent mediating effects. However, no significant mediating effect of CRP was detected. CONCLUSION: Higher exposures to Cd and Pb were positively associated with periodontitis risk. These associations might be partially mediated by the elevated levels of leukocytes rather than CRP. Further longitudinal studies are needed to elucidate the discordant results of the systemic inflammatory biomarkers.

Dementia incidence trend in England and Wales, 2002-19, and projection for dementia burden to 2040: analysis of data from the English Longitudinal Study of Ageing.

BACKGROUND: Dementia incidence declined in many high-income countries in the 2000s, but evidence on the post-2010 trend is scarce. We aimed to analyse the temporal trend in England and Wales between 2002 and 2019, considering bias and non-linearity. METHODS: Population-based panel data representing adults aged 50 years and older from the English Longitudinal Study of Ageing were linked to the mortality register across wave 1 (2002-03) to wave 9 (2018-19) (90 073 person observations). Standard criteria based on cognitive and functional impairment were used to ascertain incident dementia. Crude incidence rates were determined in seven overlapping initially dementia-free subcohorts each followed up for 4 years (ie, 2002-06, 2004-08, 2006-10, 2008-12, 2010-14, 2012-16, and 2014-18). We examined the temporal trend of dementia incidence according to age, sex, and educational attainment. We estimated the trend of dementia incidence adjusted by age and sex with Cox proportional hazards and multistate models. Restricted cubic splines allowed for potential non-linearity in the time trend. A Markov model was used to project future dementia burden considering the estimated incidence trend. FINDINGS: Incidence rate standardised by age and sex declined from 2002 to 2010 (from 10·7 to 8·6 per 1000 person-years), then increased from 2010 to 2019 (from 8·6 to 11·3 per 1000 person-years). Adjusting for age and sex, and accounting for missing dementia cases due to death, estimated dementia incidence declined by 28·8% from 2002 to 2008 (incidence rate ratio 0·71, 95% CI 0·58-0·88), and increased by 25·2% from 2008 to 2016 (1·25, 1·03-1·54). The group with lower educational attainment had a smaller decline in dementia incidence from 2002 to 2008 and a greater increase after 2008. If the upward incidence trend continued, there would be 1·7 million (1·62-1·75) dementia cases in England and Wales by 2040, 70% more than previously forecast. INTERPRETATION: Dementia incidence might no longer be declining in England and Wales. If the upward trend since 2008 continues, along with population ageing, the burden on health and social care will be large. FUNDING: UK Economic and Social Research Council.

Impact of hypertension prevalence trend on mortality and burdens of dementia and disability in England and Wales to 2060: a simulation modelling study.

BACKGROUND: Previous estimates of the impact of public health interventions targeting hypertension usually focus on one health outcome. This study aims to consider the effects of change in future hypertension prevalence on mortality, dementia, and disability simultaneously. METHODS: We modelled three plausible scenarios based on observed trends of hypertension prevalence from 2003 to 2017 in England: observed trends continue (baseline scenario); 2017 prevalence remains unchanged; and 2017 prevalence decreases by 50% by 2060. We used a probabilistic Markov model to integrate calendar trends in incidence of cardiovascular disease, dementia, disability, and mortality to forecast their future occurrence in the population of England and Wales. Assuming the hypertension prevalence trend modifies health transition probabilities, we compared mortality outcomes and the burden of dementia and disability to 2060 for the scenarios. FINDINGS: If the decline in hypertension prevalence stops, there would be a slight increase in the number of additional deaths to 2060 (22·9 [95% uncertainty interval 19·0-26·6] more deaths per 100 000 population), although the burdens of disability and dementia in absolute terms would change little. Alternatively, if the downward hypertension prevalence trend accelerates (with prevalence falling by 50% between 2017 and 2060), there would be a modest additional reduction in deaths (57·0 [50·4-63·5] fewer deaths per 100 000 population), a small increase in dementia burden (9·0 [5·1-13·2] more cases per 100 000 population), no significant effect on disability burden, and an 8% gain in healthy life expectancy at age 65 years from 2020 to 2060 (5·3 years vs 4·9 years) compared with the baseline scenario. INTERPRETATION: The major future impact of alternative hypertension prevention strategies appears to be on future life expectancy. The salutary effect of lower population blood pressure distribution on incidence of dementia and disability might not offset expansion of the susceptible population due to reduced mortality. FUNDING: British Heart Foundation and UK Economic and Social Research Council.

Sex differences in the association between dual-energy x-ray absorptiometry-measured body composition and periodontitis.

BACKGROUND: A positive association between obesity based on body mass index (BMI) and periodontitis has been reported. Fat tissue-related systemic inflammation acts as the link to periodontal comorbidities of obesity. However, the BMI is unable to distinguish fat and fat-free tissues. More precise measures are required to evaluate body composition, including fat and fat-free tissues. This study aimed to determine the sex differences in the association between dual-energy x-ray absorptiometry (DXA)-measured body composition (i.e., fat mass and muscle mass) and phenotypes with periodontitis. METHODS: Cross-sectional data of 3892 participants from the National Health and Nutrition Examination Survey (NHANES) study 2011-2014 were analyzed. Adiposity indices (fat mass index [FMI] and percentage body fat [%BF]) and muscle mass index (MMI) were calculated. The participants were categorized by the quintiles of FMI, MMI, and %BF. Body composition phenotypes were categorized as: low adiposity-low muscle (LA-LM), low adiposity-high muscle (LA-HM), high adiposity-low muscle (HA-LM), or high adiposity-high muscle (HA-HM), respectively. Periodontitis was defined by the CDC/AAP (Centers for Disease Control and Prevention/American Academy of Periodontology) criteria. Multivariable logistic regression analysis was conducted, stratified by sex. We further adjusted for white blood cell (WBC) counts in the sensitivity analysis. RESULTS: Restricted cubic splines revealed non-linear associations between body composition indices and periodontitis risk. Women with a higher FMI (odds ratio for Q5 vs. Q1 [ORQ5vs1 ] = 1.787, 95% confidence interval: 1.209-2.640) or %BF (ORQ5vs1  = 2.221, 1.509-3.268) had increased odds of periodontitis. In addition, women with HA-LM phenotype were more likely to develop periodontitis (OR = 1.528, 1.037-2.252). Interestingly, the WBC count, a systemic inflammatory biomarker, attenuated these associations. No statistically significant associations were found in men. CONCLUSIONS: The association between DXA-measured body composition and phenotypes with periodontitis differs per sex. Only in women higher adiposity indices and HA-LM phenotype were associated with an increased risk of periodontitis.

Object Affinity Learning: Towards Annotation-Free Instance Segmentation.

We address the problem of annotation-free instance segmentation in the wild, aiming to relieve the expensive cost of manual mask annotations. Existing approaches utilize appearance cues, such as color, edge, and texture information, to generate pseudo masks for instance segmentation. However, due to the ambiguity of defining an object by visual appearance alone, these methods fail to distinguish objects from the background under complex scenes. Beyond visual cues, objects are one-piece in space and move together over time, which indicates that geometry cues, such as spatial continuity and motion consistency, are also exploitable for this problem. To directly utilize geometry cues, we propose an affinity-based paradigm for annotation-free instance segmentation. The new paradigm is called object affinity learning, a proxy task of annotation-free instance segmentation, which aims to tell whether two pixels come from the same object by learning feature representation from geometry cues. During inference, the learned object affinity could be further converted into instance segmentation masks by some graph partition algorithms. The proposed object affinity learning achieves much better instance segmentation performance than existing pseudo-mask-based methods on the large-scale Waymo Open Dataset and KITTI dataset.

Growing old in China in socioeconomic and epidemiological context: systematic review of social care policy for older people.

BACKGROUND: From 2020 to 2050, China's population aged ≥65 years old is estimated to more than double from 172 million (12·0%) to 366 million (26·0%). Some 10 million have Alzheimer's disease and related dementias, to approach 40 million by 2050. Critically, the population is ageing fast while China is still a middle-income country. METHODS: Using official and population-level statistics, we summarise China's demographic and epidemiological trends relevant to ageing and health from 1970 to present, before examining key determinants of China's improving population health in a socioecological framework. We then explore how China is responding to the care needs of its older population by carrying out a systematic review to answer the question: 'what are the key policy challenges to China achieving an equitable nationwide long-term care system for older people?'. Databases were screened for records published between 1st June 2020 and 1st June 2022 in Mandarin Chinese or English, reflecting our focus on evidence published since introduction of China's second long-term care insurance pilot phase in 2020. RESULTS: Rapid economic development and improved access to education has led to widescale internal migration. Changing fertility policies and household structures also pose considerable challenges to the traditional family care model. To deal with increasing need, China has piloted 49 alternative long-term care insurance systems. Our findings from 42 studies (n = 16 in Mandarin) highlight significant challenges in the provision of quality and quantity of care which suits the preference of users, varying eligibility for long-term care insurance and an inequitable distribution of cost burden. Key recommendations include increasing salaries to attract and retain staff, introduction of mandatory financial contributions from employees and a unified standard of disability with regular assessment. Strengthening support for family caregivers and improving smart old age care capacity can also support preferences to age at home. CONCLUSIONS: China has yet to establish a sustainable funding mechanism, standardised eligibility criteria and a high-quality service delivery system. Its long-term care insurance pilot studies provide useful lessons for other middle-income countries facing similar challenges in terms of meeting the long-term care needs of their rapidly growing older populations.

The Southern European Atlantic diet and depression risk: a European multicohort study.

The Southern European Atlantic diet (SEAD) is the traditional dietary pattern of north-western Spain and northern Portugal, but it may resemble that of other European countries. The SEAD has been found associated with lower risk for myocardial infarction and mortality. Since dietary patterns may also influence mental health, we examined the association between the SEAD and depression risk in southern, central, eastern, and western European populations. We conducted a prospective analysis of five cohorts (13,297 participants aged 45-92 years, free of depression at baseline): Seniors-ENRICA-1 and Seniors-ENRICA-2 (Spain), HAPIEE (Czechia and Poland), and Whitehall-II (United Kingdom). The SEAD comprised cod, other fresh fish, red meat and pork products, dairy, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and moderate wine consumption. Depression at follow-up was defined according to presence of depressive symptoms (based on available scales), use of prescribed antidepressants, inpatient admissions, or self-reported diagnosis. Associations were adjusted for sociodemographic, lifestyle, and dietary variables. During a median follow-up of 3.9 years (interquartile range 3.4-4.9), there were 1437 new depression cases. Higher adherence to the SEAD was associated with lower depression risk in the pooled sample. Individual food groups showed a similar tendency, albeit non-significant. The fully adjusted odds ratio (95% confidence interval) per 1-standard deviation increment in the SEAD was 0.91 (0.86, 0.96). This association was rather consistent across countries [Spain = 0.86 (0.75, 0.99), Czechia = 0.86 (0.75, 0.99), Poland = 0.97 (0.89, 1.06), United Kingdom = 0.85 (0.75, 0.97); p for interaction = 0.24], and was of similar magnitude as that found for existing healthy dietary patterns. In conclusion, the SEAD was associated with lower depression risk across European populations. This may support the development of mood disorder guidelines for Southern European Atlantic regions based on their traditional diet, and for central, eastern, and western European populations based on the SEAD food groups that are culturally rooted in these places.

Comparison of functional and oncological outcome of conformal sphincter preservation operation, low anterior resection, and abdominoperineal resection in very low rectal cancer: a retrospective comparative cohort study with propensity score matching.

PURPOSE: Conformal sphincter preservation operation (CSPO) procedure is a sphincter preservation procedure for preserving the anal canal function for very low rectal cancers. This study investigated the functional and oncological outcome of conformal sphincter preservation operation by comparing with low anterior resection (LAR) and abdominoperineal resection (APR). METHODS: This is a retrospective comparative study. Patients who received conformal sphincter preservation operation (n = 52), low anterior resection (n = 54), or abdominoperineal resection (n = 69) were included between 2011 and 2016 in a tertiary referral hospital. Propensity score matching was applied to adjust the baseline characteristics which may influence the choice of the surgical procedure. RESULTS: Twenty-one pairs of conformal sphincter preservation operation vs. low anterior resection and 29 pairs of conformal sphincter preservation operation vs. abdominoperineal resection were selected. The first group had a higher tumor location than the second group. Compared with the low anterior resection group, the conformal sphincter preservation operation group had shorter distal resection margins; however, no significant differences were identified in daily stool frequency, Wexner incontinence score, local recurrence, distant metastasis, overall survival, and disease-free survival between both groups. Compared with the abdominoperineal resection group, the conformal sphincter preservation operation group had shorter operative time and shorter postoperative hospital stay. No significant differences were identified in local recurrence, distant metastasis, overall survival, and disease-free survival. CONCLUSION: Conformal sphincter preservation operation is oncologically safe compared to APR and LAR, and has similar functional findings to LAR. Studies comparing CSPO with intersphincteric resection should be performed.

Association between the quality of plant-based diets and periodontitis in the U.S. general population.

AIM: To investigate the relationship between plant-based diet indices (PDIs) and periodontitis and serum IgG antibodies against periodontopathogens in the U.S. MATERIALS AND METHODS: We analysed cross-sectional data on 5651 participants ≥40 years of age from the Third National Health and Nutrition Examination Survey. Food frequency questionnaire data were used to calculate the overall PDI, healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI). Periodontitis was defined using a half-reduced Centers for Disease Control and Prevention and American Academy of Periodontology case definition. Serum antibodies against 19 periodontopathogens were used to classify the population into two subgroups using hierarchical clustering. Survey-weighted multivariable logistic regressions were applied to assess the associations of PDI/hPDI/uPDI z-scores with periodontitis and hierarchical clusters after adjusting for potential confounders. RESULTS: A total of 2841 (50.3%) participants were defined as having moderate/severe periodontitis. The overall PDI z-score was not significantly associated with the clinical and bacterial markers of periodontitis. By considering the healthiness of plant foods, we observed an inverse association between hPDI z-score and periodontitis (odds ratio [OR] = 0.925, 95% confidence interval [CI]: 0.860-0.995). In contrast, higher uPDI z-score (adherence to unhealthful plant foods) might increase the risk of periodontitis (OR = 1.100; 95% CI: 1.043-1.161). Regarding antibodies against periodontopathogens, the participants in cluster 2 had higher periodontal antibodies than those in cluster 1. The hPDI z-score was positively associated with cluster 2 (OR = 1.192; 95% CI: 1.112-1.278). In contrast, an inverse association between uPDI z-score and cluster 2 was found (OR = 0.834; 95% CI: 0.775-0.896). CONCLUSIONS: Plant-based diets were associated with periodontitis, depending on their quality. A healthy plant-based diet was inversely related to an increased risk of periodontitis but positively related to elevated antibody levels against periodontopathogens. For an unhealthy plant-based diet, the opposite trends were observed.

Spatiotemporal distribution and control measure evaluation of droplets and aerosol clouds in dental procedures.

We evaluated the distributions of dental splatters and the corresponding control measure effects with high-speed videography and laser diffraction. Most of the dental splatters were small droplets (<50 µm). High-volume evacuation combined with a suction air purifier could clear away most of the droplets and aerosols.

Serum Antioxidant Vitamins Mediate the Association between Periodontitis and Metabolically Unhealthy Overweight/Obesity.

BACKGROUND: Periodontal disease is associated with metabolic syndrome and obesity. This cross-sectional study aimed to investigate whether serum antioxidant vitamins could mediate the association between periodontitis and a metabolically unhealthy phenotype in the overweight and obese population; Methods: We included 6158 Americans (body mass index (BMI) ≥ 25 kg/m2) from the Third National Health and Nutrition Examination Survey (NHANES III). Periodontitis was defined using a half-reduced CDC/AAP (Centers for Disease Control and Prevention/American Academy of Periodontology) definition. Having two or more metabolic abnormalities was defined as a metabolically unhealthy overweight and obese (MUO) phenotype. Mediation analysis of four oxidative stress biomarkers (serum antioxidant vitamins A, C, D, and E) was conducted; Results: Of participants with overweight and obesity, 2052 (33.3%) Americans were categorized as having periodontitis. Periodontitis increased dyslipidemia risk and systemic inflammation in the overweight and obese population. In the multivariable logistic regression model, periodontitis was positively associated with MUO (adjusted odds ratio = 1.238; 95% confidence interval: 1.091 to 1.406). These findings were validated in an independent cohort. Serum vitamins C and D were estimated to mediate 19.3% and 8.4% of the periodontitis-MUO association. CONCLUSIONS: Periodontitis might decrease serum vitamins C and D and induce a metabolically unhealthy state among adults with overweight and obesity.

Denture wearing status, cardiovascular health profiles, and mortality in edentulous patients: A prospective study with a 27-year follow-up.

OBJECTIVES: Life's Simple 7 (LS7) metrics provide insight into improving cardiovascular health (CVH) and help reduce mortality risks. Edentulous older adults have a higher mortality risk than dentulous ones, probably due to worse oral function. It is reported that wearing dentures will decrease the mortality risk factor by improving oral function. This prospective study aimed to investigate if denture wearing could modify the association between CVH profile and mortality risk among edentulous elderly. METHODS: From the Third National Health and Nutrition Examination Survey (NHANES III), 1,735 edentulous older adults (mean age 69.4 years old) with CVH profiles and data on denture wearing status were selected for this study. CVH profiles according to LS7 metrics were classified into poor, intermediate, or ideal. Denture wearers were defined as those wearing complete dentures in both arches all the time or only when awake. Multivariable Cox proportional-hazards regression was conducted to estimate the association of CVH profiles with all-cause and cardiovascular mortality. Stratified analyses and the testing of interaction terms were used to evaluate the difference between the association in edentulous patients with and without dentures. RESULTS: A total of 1,420 (81.8%) older adults died during the 27-year follow-up, with 478 (27.6%) cases attributable to heart disease. After controlling for potential confounders, edentulous patients with an ideal CVH (LS7 = 10-14) had a lower mortality risk than those with poor CVH (LS7 = 0-4). Furthermore, we observed an effect modification by denture use (Pinteraction = 0.046), with the role of ideal CVH in mitigating mortality among the denture wearers (Hazard Ratio = 0.440 [0.329-0.588]), while no significant association among those without dentures. Similar results were achieved for cardiovascular mortality, but there was no effect modification of denture use (Pinteraction = 0.352). CONCLUSION: In this study, a favorable cardiovascular health profile presents a protective effect on all-cause mortality only among edentulous patients wearing dentures instead of non-wearer. CLINICAL SIGNIFICANCE: Denture usage could improve oral function (e.g., chewing, smiling, speaking, etc.) and promote general health. Effect modification found in this study indicates having ideal CVH alone cannot substantially reduce mortality risk among edentulous patients. Therefore, health care professionals should keep an eye on the elderly not wearing dentures as they are probably more at risk for adverse health outcomes. It remains unclear if denture wearing has a causal relation with lower mortality risks, and further research is needed.

Is there a common latent cognitive construct for dementia estimation across two Chinese cohorts?

Introduction: It is valuable to identify common latent cognitive constructs for dementia prevalence estimation across Chinese aging cohorts. Methods: Based on cognitive measures of 12015 Chinese Longitudinal Healthy Longevity Survey (CLHLS; 13 items) and 6623 China Health and Retirement Longitudinal Study (CHARLS; 9 items) participants aged 65 to 99 in 2018, confirmatory factor analysis was applied to identify latent cognitive constructs, and to estimate dementia prevalence compared to Mini-Mental State Examination (MMSE) and nationwide estimates of the literature. Results: A common three-factor cognitive construct of orientation, memory, and executive function and language was found for both cohorts with adequate model fits. Crude dementia prevalence estimated by factor scores was similar to MMSE in CLHLS, and was more reliable in CHARLS. Age-standardized dementia estimates of CLHLS were lower than CHARLS among those aged 70+, which were close to the nationwide prevalence reported by the COAST study and Global Burden of Disease. Discussion: We verified common three-factor cognitive constructs for both cohorts, providing an approach to estimate dementia prevalence at the national level. Highlights: Common three-factor cognitive constructs were identified in Chinese Longitudinal Healthy Longevity Survey (CLHLS) and China Health and Retirement Longitudinal Study (CHARLS).Crude dementia estimates using factor scores were reliable in both cohorts.Estimates of CHARLS were close to current evidence, but higher than that of CLHLS.

Risk Prediction of Second Primary Malignancies in Primary Early-Stage Ovarian Cancer Survivors: A SEER-Based National Population-Based Cohort Study.

Purpose: This study aimed to characterize the clinical features of early-stage ovarian cancer (OC) survivors with second primary malignancies (SPMs) and provided a prediction tool for individualized risk of developing SPMs. Methods: Data were obtained from the Surveillance, Epidemiology and End Results (SEER) database during 1998-2013. Considering non-SPM death as a competing event, the Fine and Gray model and the corresponding nomogram were used to identify the risk factors for SPMs and predict the SPM probabilities after the initial OC diagnosis. The decision curve analysis (DCA) was performed to evaluate the clinical utility of our proposed model. Results: A total of 14,314 qualified patients were enrolled. The diagnosis rate and the cumulative incidence of SPMs were 7.9% and 13.6% [95% confidence interval (CI) = 13.5% to 13.6%], respectively, during the median follow-up of 8.6 years. The multivariable competing risk analysis suggested that older age at initial cancer diagnosis, white race, epithelial histologic subtypes of OC (serous, endometrioid, mucinous, and Brenner tumor), number of lymph nodes examined (<12), and radiotherapy were significantly associated with an elevated SPM risk. The DCA revealed that the net benefit obtained by our proposed model was higher than the all-screening or no-screening scenarios within a wide range of risk thresholds (1% to 23%). Conclusion: The competing risk nomogram can be potentially helpful for assisting physicians in identifying patients with different risks of SPMs and scheduling risk-adapted clinical management. More comprehensive data on treatment regimens and patient characteristics may help improve the predictability of the risk model for SPMs.

Periodontitis and cognitive impairment in older adults: The mediating role of mitochondrial dysfunction.

BACKGROUND: Increased attention has been focused on the associations of periodontal disease with the onset and progression of cognitive impairment. Although the associations are likely to be multifactorial, few studies have explored the role of mitochondrial dysfunction in the periodontitis-dementia link. METHODS: Cross-sectional data of 1,883 participants aged ≥60 years in the National Health and Nutrition Examination Survey 2011-2014 were analyzed. The following data were collected: 1) general information on sociodemographic, behavioral, and health-related factors; 2) periodontal status (mean attachment loss [AL] and mean probing depth [PD]); 3) mitochondrion-derived biomarker of mitochondrial dysfunction (blood sample concentration of methylmalonic acid [MMA]); 4) cognitive function (Consortium to Establish a Registry for Alzheimer's disease immediate recall [CERAD-IR] and delay recall [CERAD-DR], animal fluency test, and digit symbol substitution test [DSST]). Mediation analysis weighted for complex survey design was used to assess the effect of MMA on the association of periodontal status with cognitive function after adjusting for potential confounders. RESULTS: Participants with Stage III and IV periodontitis had lower scores on cognitive performance and higher MMA levels than those with Stages I/II periodontitis. Circulating MMA was significantly associated with CERAD-DR (weighted ß [SE] = -0.076 [0.011]) and DSST (weighted ß [SE] = -0.039 [0.009]), which mediated 9.9% and 6.0% of the total association of mean PD with cognitive function. Moreover, MMA mediated 11.7% and 5.8% of the association of mean AL with CERAD-DR and DSST, respectively. CONCLUSION: The findings suggest that MMA, a biomarker of mitochondrial dysfunction, plays a mediating role in the link between periodontitis and cognitive impairment in older adults aged ≥60 years.

Efficacy and safety of 3D printing-assisted percutaneous nephrolithotomy in complex renal calculi.

This study evaluated the efficacy and safety of 3D printing technology combined with percutaneous nephrolithotomy in the treatment of complex renal calculi. Ninety patients with complex renal calculi were randomly divided into a 3D printing group (45 patients) and a control group (45 patients). In the 3D printing group, a patient-specific 1:1 3D printing model was established based on the patient's thin-layer CT scanning data. A 3D printing model was used for preoperative communication between doctors and patients. Preoperative puncture training, channel design, residual stone prediction, and percutaneous nephrolithotomy were performed under the guidance of a 3D printing model and B-ultrasound. The control group was treated with the conventional B-ultrasound-guided puncture method. Results suggest that there was a statistically significant difference between the two groups (P < 0.05). The overall score of the doctor-patient communication objects in the 3D printing group was 19.32 ± 1.57 points, and in the control group, it was 14.51 ± 2.13 points. The operation time of the 3D printing group was 103.21 ± 13.49 min, and that of the control group was 126.12 ± 25.87 min. The calculi clearance rate of the 3D printing group was 96%, while that of the control group was 80%. The incidence of postoperative complications was 6.67% in the 3D printing group and 22.22% in the control group. Compared with traditional percutaneous nephrolithotomy, 3D printing technology combined with percutaneous nephrolithotomy can significantly enhance the effectiveness of doctor-patient communication, shorten operation time, reduce operation bleeding, improve the stone clearance rate, reduce the incidence of complications and shorten the length of hospital stay. The proposed method is thus a safe and effective method to treat complex renal calculi.

Combined association of cognitive impairment and poor oral health on mortality risk in older adults: Results from the NHANES with 15 years of follow-up.

BACKGROUND: Cognitive impairment and poor oral health are frequently seen among older adults. Both conditions have been identified as risk factors for mortality. However, the combined associations of cognitive impairment and poor oral health with mortality have not been well studied and are therefore the aim of this cohort study. METHODS: We analyzed data from the National Health and Nutrition Examination Survey (1999-2002) linked with mortality data obtained from the 2015 public-use linked mortality file. Cognitive impairment was defined as a digit symbol substitution test score lower than the lowest quartile. Oral health status was assessed based on presence of untreated caries, moderate to severe periodontitis, and edentulism. The combined effects of caries/periodontitis or edentulism and cognitive impairment on all-cause and cardiometabolic mortality were examined using the Cox proportional hazard models after adjusting for potential confounders including demographic characteristics, lifestyle, biomarkers, and comorbidities. RESULTS: In total, 1973 participants were enrolled in the prospective study. At a median follow-up of 13.4 years, 978 participants had died (264 deaths because of cardiometabolic disease). Cognitive impairment, periodontitis, and edentulism were each found to be significant predictors of all-cause mortality. Caries, however, was not significantly related to mortality. When analyzing these predictors in combination, a diagnosis of cognitive impairment and periodontitis was associated with an 83.1% increase in all-cause mortality risk and an 87.7% increase in cardiometabolic mortality risk compared with healthy controls. Similarly, the risk for all-cause mortality was highest in cases where impaired cognition and edentulism co-occurred (adjusted hazard ratio = 1.701, 1.338-2.161). CONCLUSION: Concomitant presence of cognitive impairment and periodontitis or edentulism can be associated with a higher risk of mortality among older U.S. adults.