Transcriptional profiling of retinal astrocytes identifies a specific marker and points to functional specialization.

Astrocyte heterogeneity is an increasingly prominent research topic, and studies in the brain have demonstrated substantial variation in astrocyte form and function, both between and within regions. In contrast, retinal astrocytes are not well understood and remain incompletely characterized. Along with optic nerve astrocytes, they are responsible for supporting retinal ganglion cell axons and an improved understanding of their role is required. We have used a combination of microdissection and Ribotag immunoprecipitation to isolate ribosome-associated mRNA from retinal astrocytes and investigate their transcriptome, which we also compared to astrocyte populations in the optic nerve. Astrocytes from these regions are transcriptionally distinct, and we identified retina-specific astrocyte genes and pathways. Moreover, although they share much of the "classical" gene expression patterns of astrocytes, we uncovered unexpected variation, including in genes related to core astrocyte functions. We additionally identified the transcription factor Pax8 as a highly specific marker of retinal astrocytes and demonstrated that these astrocytes populate not only the retinal surface, but also the prelaminar region at the optic nerve head. These findings are likely to contribute to a revised understanding of the role of astrocytes in the retina.

Posture, Gait, Quality of Life, and Hearing with a Vestibular Implant.

BACKGROUND: Bilateral vestibular hypofunction is associated with chronic disequilibrium, postural instability, and unsteady gait owing to failure of vestibular reflexes that stabilize the eyes, head, and body. A vestibular implant may be effective in alleviating symptoms. METHODS: Persons who had had ototoxic (7 participants) or idiopathic (1 participant) bilateral vestibular hypofunction for 2 to 23 years underwent unilateral implantation of a prosthesis that electrically stimulates the three semicircular canal branches of the vestibular nerve. Clinical outcomes included the score on the Bruininks-Oseretsky Test of Motor Proficiency balance subtest (range, 0 to 36, with higher scores indicating better balance), time to failure on the modified Romberg test (range, 0 to 30 seconds), score on the Dynamic Gait Index (range, 0 to 24, with higher scores indicating better gait performance), time needed to complete the Timed Up and Go test, gait speed, pure-tone auditory detection thresholds, speech discrimination scores, and quality of life. We compared participants' results at baseline (before implantation) with those at 6 months (8 participants) and at 1 year (6 participants) with the device set in its usual treatment mode (varying stimulus pulse rate and amplitude to represent rotational head motion) and in a placebo mode (holding pulse rate and amplitude constant). RESULTS: The median scores at baseline and at 6 months on the Bruininks-Oseretsky test were 17.5 and 21.0, respectively (median within-participant difference, 5.5 points; 95% confidence interval [CI], 0 to 10.0); the median times on the modified Romberg test were 3.6 seconds and 8.3 seconds (difference, 5.1; 95% CI, 1.5 to 27.6); the median scores on the Dynamic Gait Index were 12.5 and 22.5 (difference, 10.5 points; 95% CI, 1.5 to 12.0); the median times on the Timed Up and Go test were 11.0 seconds and 8.7 seconds (difference, 2.3; 95% CI, -1.7 to 5.0); and the median speeds on the gait-speed test were 1.03 m per second and 1.10 m per second (difference, 0.13; 95% CI, -0.25 to 0.30). Placebo-mode testing confirmed that improvements were due to treatment-mode stimulation. Among the 6 participants who were also assessed at 1 year, the median within-participant changes from baseline to 1 year were generally consistent with results at 6 months. Implantation caused ipsilateral hearing loss, with the air-conducted pure-tone average detection threshold at 6 months increasing by 3 to 16 dB in 5 participants and by 74 to 104 dB in 3 participants. Changes in participant-reported disability and quality of life paralleled changes in posture and gait. CONCLUSIONS: Six months and 1 year after unilateral implantation of a vestibular prosthesis for bilateral vestibular hypofunction, measures of posture, gait, and quality of life were generally in the direction of improvement from baseline, but hearing was reduced in the ear with the implant in all but 1 participant. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT02725463.).

Cotinuous precision separation of gold using a metal-organic framework/polymer composite.

Critical metals of environmental and economic relevance can be found within complex mixtures, such as mine tailings, electronic waste and wastewater, at trace amounts. Specifically, gold is a critical metal that carries desired redox active properties in various applications, including modern electronics, medicine and chemical catalysis. Here we report the structuring of sub-micron Fe-BTC/PpPDA crystallites into larger 250µm or 500µm granules for continuous packed bed experiments for the precision separation of gold. The Structured Fe-BTC/PpPDA is highly crystalline and porous with a BET surface area of 750 m2g-1. Further, the hybrid nanocomposite material maintains its selectivity for gold ions over common inorganic interferents. The structuring approach reported prevents excessive pressure drop and ensures stability over time and operation in a packed bed column. Further, we demonstrate that the Structured Fe-BTC/PpPDA can concentrate at least 42 wt% of gold under a dynamic continuous flow operation. These findings highlight the potential of Structured Fe-BTC/PpPDA for practical applications in industry, particularly in the selective capture of gold from complex mixtures.

Prevalence and burden of migraine in the United States: A systematic review.

BACKGROUND: This study reviewed migraine prevalence and disability gathered through epidemiologic survey studies in the United States conducted over the past three decades. We summarized these studies and evaluated changing patterns of disease prevalence and disability. METHODS: We conducted a systematic review of US studies addressing the prevalence, disability, and/or burden of migraine, including both episodic migraine (EM) and chronic migraine (CM). A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was used in conjunction with the PubMed search engine. Eligible studies were published before February 2022, were conducted in the United States, included representative samples, and used a case definition of migraine based on the International Classification of Headache Disorders (ICHD). The primary measure of disease burden was the Migraine Disability Assessment Scale (MIDAS). The MIDAS measures days lost due to migraine over 3 months in three domains and defines groups with moderate (Grade III) or severe disability (Grade IV) using cut-scores. RESULTS: Of the 1609 identified records, 26 publications from 11 US population-based studies met eligibility criteria. The prevalence of migraine in the population has remained relatively consistent for the past 30 years: ranging from 11.7% to 14.7% overall, 17.1% to 19.2% in women, and 5.6% to 7.2% in men in the studies reviewed. CM prevalence is 0.91% (1.3% among women and 0.5% of men) in adults and 0.8% in adolescents. The proportion of people with migraine and moderate-to-severe MIDAS disability (Grades III-IV), has trended upward across studies from 22.0% in 2005 to 39.0% in 2012, to 43.2% in 2016, and 42.4% in 2018. A consistently higher proportion of women were assigned MIDAS Grades III/IV relative to men. CONCLUSION: The prevalence of migraine in the United States has remained stable over the past three decades while migraine-related disability has increased. The disability trend could reflect changes in reporting, study methodology, social and societal changes, or changes in exacerbating or remediating factors that make migraine more disabling, among other hypotheses. These issues merit further investigation.

Disparities in Access to Robotic Knee Arthroplasty: A Geospatial Analysis.

BACKGROUND: The utilization of robotic knee arthroplasty (RKA) continues to increase across the United States. The aim of this geospatial analysis was to elucidate if RKA is distributed uniformly across the United States or if disparities exist in patient access. METHODS: Publicly available provider-finding functions for 5 major manufacturers of RKA systems were used to obtain the practice locations of surgeons performing RKA along with their associated RKA system manufacturer. The average travel distance for each county to the nearest RKA surgeon was calculated and Moran's index clustering analysis was used to find hotspots and coldspots of RKA access. A logistic regression model was used to identify the predictive odds ratios between robotic hotspots and coldspots with county-level sociodemographic variables. Of the 34,216 currently practicing orthopedic surgeons in 2022, 2,571 have access to robotic assistance for knee arthroplasty. RESULTS: Hotspots of increased travel time were predominantly in West South Central and West North Central census regions. Hotspots were significantly more rural and consisted of predominantly White populations, with lower median income and health insurance coverage. CONCLUSIONS: The results of the current study align with existing literature, demonstrating absolute geographic access disparities for rural and economically disadvantaged populations. Additionally, relative access disparities persist for minority populations and individuals with high comorbidity burdens residing in urban areas.

Tunable non-reciprocal waveguide using spoof plasmon polariton coupling to a gaseous magnetoplasmon.

We experimentally demonstrate non-reciprocal (one-way) waveguiding in a microstrip transmission line tailored to support the propagation of spoof plasmon polaritons. Time-reversal symmetry is broken by coupling the microstrip fields to a magnetized gaseous plasma discharge column thereby exciting non-reciprocal magnetoplasmons at the interface between the plasma and a surrounding quartz envelope. The magnetic bias introduces asymmetry in the dispersion of the surface plasmon polaritons at the gaseous plasma-dielectric interface, resulting in a breaking of the bidirectionality of the wave propagation in the microstrip. The isolation generated at conditions of modest magnetic bias is measured to be nearly 60 dB, and tunable by varying the plasma density through the voltage applied to the discharge. The advantage of using magnetized gaseous plasmas to produce this unidirectional waveguide structure is that it can be turned on or off at rates limited by the production and recombination of the plasma.

Individual astrocyte morphology in the collagenous lamina cribrosa revealed by multicolor DiOlistic labeling.

Astrocytes in the lamina region of the optic nerve head play vital roles in supporting retinal ganglion cell axon health. In glaucoma, these astrocytes are implicated as early responders to stressors, undergoing characteristic changes in cell function as well as cell morphology. Much of what is currently known about individual lamina astrocyte morphology has been learned from rodent models which lack a defining feature of the human optic nerve head, the collagenous lamina cribrosa (LC). Current methods available for evaluation of collagenous LC astrocyte morphology have significant shortcomings. We aimed to evaluate Multicolor DiOlistic labeling (MuDi) as an approach to reveal individual astrocyte morphologies across the collagenous LC. Gold microcarriers were coated with all combinations of three fluorescent cell membrane dyes, DiI, DiD, and DiO, for a total of seven dye combinations. Microcarriers were delivered to 150 µm-thick coronal vibratome slices through the LC of pig, sheep, goat, and monkey eyes via MuDi. Labeled tissues were imaged with confocal and second harmonic generation microscopy to visualize dyed cells and LC collagenous beams, respectively. GFAP labeling of DiOlistically-labeled cells with astrocyte morphologies was used to investigate cell identity. 3D models of astrocytes were created from confocal image stacks for quantification of morphological features. DiOlistic labeling revealed fine details of LC astrocyte morphologies including somas, primary branches, higher-order branches, and end-feet. Labeled cells with astrocyte morphologies were GFAP+. Astrocytes were visible across seven distinct color channels, allowing high labeling density while still distinguishing individual cells from their neighbors. MuDi was capable of revealing tens to hundreds of collagenous LC astrocytes, in situ, with a single application. 3D astrocyte models allowed automated quantification of morphological features including branch number, length, thickness, hierarchy, and straightness as well as Sholl analysis. MuDi labeling provides an opportunity to investigate morphologies of collagenous LC astrocytes, providing both qualitative and quantitative detail, in healthy tissues. This approach may open doors for research of glaucoma, where astrocyte morphological alterations are thought to coincide with key functional changes related to disease progression.

Validation of a Novel Method of Measuring Cup Orientation Using BiPlanar Simultaneous Radiographic Images.

BACKGROUND: Accurate acetabular component positioning is paramount to the success of total hip arthroplasty (THA). Two-dimensional imaging alone remains a popular tool for implant position assessment despite known limitations. We investigated the accuracy of a novel method for assessing acetabular component position based upon orthogonal simultaneous biplanar X-ray images. METHODS: There were forty consecutive patients who had a preexisting THA on the contralateral side who underwent both computed tomography (CT) and simultaneous orthogonal biplanar radiographic scans for preoperative planning of THA. The operative inclination (OI) and operative anteversion (OA) of the acetabular cup were calculated by a new measurement method using the biplanar simultaneous scans. Those measurements were compared to measurement of the cup orientation on CT. The measurements were made by 2 independent observers. Interobserver correlation coefficients were calculated between the 2 observers to measure reliability. RESULTS: The mean error in OA measurement of the acetabular cup between simultaneous orthogonal biplanar radiographic and CT imaging was 0.5° (SD: 1.9°, minimum -4.0°, maximum 5.0°), the mean error in OI was 0.0° (SD: 1.7°, minimum -5.0°, maximum 4.0°). The average absolute error was 1.5° for OA and 1.2° for OI. Interobserver correlation coefficient was 0.83 for OA and 0.93 for OI. CONCLUSION: The novel method of measuring cup orientation using simultaneous biplanar radiographic scans utilized in this study was accurate and reproducible between observers compared to CT measurements.

Microglia depletion exacerbates retinal ganglion cell loss in a mouse model of glaucoma.

To test whether depletion of microglia in the optic nerve head has a beneficial effect on retinal ganglion cell numbers and function, we depleted microglia by oral administration of the CSF1R antagonist PLX5622. Then, ocular hypertension was induced by unilateral injection of magnetic microbeads into the anterior chamber. Visual function was assessed with pattern electroretinography and measurement of the optomotor reflex. Retinal ganglion cell bodies and axons were counted and gene expression patterns in optic nerve head astrocytes were tested on freshly dissociated astrocytes. PLX5622 efficiently depleted microglia in the retina and the optic nerve head, but about 20% of microglia persisted in the myelinated optic nerve proper even after prolonged exposure to the drug. PLX5622 did not affect ganglion cell function by itself. Elevation of the IOP for four weeks led to the expected decrease in visual acuity and pattern ERG amplitude. Microglia ablation did not affect these parameters. Ganglion cell and axon numbers were counted histologically post mortem. Mice in the microglia depletion group showed a moderate but significantly greater loss of ganglion cells than the control group. At four weeks post microbead injection, gene expression patterns in optic nerve head astrocytes are consistent with an A2 (or neuroprotective) pattern. Microglia depletion blunted the up-regulation of A2 genes in astrocytes. In conclusion, microglia depletion is unlikely to protect retinal ganglion cells in early glaucoma.

A Novel Driving Noise Analysis Method for On-Road Traffic Detection.

Effective noise reduction and abnormal feature extraction are important for abnormal sound detection occurring in urban traffic operations. However, to improve the detection accuracy of continuous traffic flow and even overlapping vehicle bodies, effective methods capable to achieve accurate signal-to-noise ratio and appropriate characteristic parameters should be explored. In view of the disadvantages of traditional traffic detection methods, such as Short-Time Energy (STE) and Mel Frequency Cepstral Coefficients (MFCC), this study adopts an improved spectral subtraction method to analyze traffic noise. Through the feature fusion of STE and MFCC coefficients, an innovative feature parameter, E-MFCC, is obtained, assisting to propose a traffic noise detection solution based on Triangular Wave Analysis (TWA). APP Designer in MATLAB was used to establish a traffic detection simulation platform. The experimental results showed that compared with the accuracies of traffic detection using the traditional STE and MFCC methods as 67.77% and 76.01%, respectively, the detection accuracy of the proposed TWA is significantly improved, attaining 91%. The results demonstrated the effectiveness of the traffic detection method proposed in solving the overlapping problem, thus achieving accurate detection of road traffic volume and improving the efficiency of road operation.

Preparation of Highly Porous Metal-Organic Framework Beads for Metal Extraction from Liquid Streams.

Metal-organic frameworks (MOFs) offer great promise in a variety of gas- and liquid-phase separations. However, the excellent performance on the lab scale hardly translates into pilot- or industrial-scale applications due to the microcrystalline nature of MOFs. Therefore, the structuring of MOFs into pellets or beads is a highly solicited and timely requirement. In this work, a general structuring method is developed for preparing MOF-polymer composite beads based on an easy polymerization strategy. This method adopts biocompatible, biodegradable poly(acrylic acid) (PAA) and sodium alginate monomers, which are cross-linked using Ca2+ ions. Also, the preparation procedure employs water and hence is nontoxic. Moreover, the universal method has been applied to 12 different structurally diverse MOFs and three MOF-based composites. To validate the applicability of the structuring method, beads consisting of a MOF composite, namely Fe-BTC/PDA, were subsequently employed for the extraction of Pb and Pd ions from real-world water samples. For example, we find that just 1 g of Fe-BTC/PDA beads is able to decontaminate >10 L of freshwater containing highly toxic lead (Pb) concentrations of 600 ppb while under continuous flow. Moreover, the beads offer one of the highest Pd capacities to date, 498 mg of Pd per gram of composite bead. Furthermore, large quantities of Pd, 7.8 wt %, can be readily concentrated inside the bead while under continuous flow, and this value can be readily increased with regenerative cycling.

Defining and distinguishing infant behavioral states using acoustic cry analysis: is colic painful?

BACKGROUND: To characterize acoustic features of an infant's cry and use machine learning to provide an objective measurement of behavioral state in a cry-translator. To apply the cry-translation algorithm to colic hypothesizing that these cries sound painful. METHODS: Assessment of 1000 cries in a mobile app (ChatterBabyTM). Training a cry-translation algorithm by evaluating >6000 acoustic features to predict whether infant cry was due to a pain (vaccinations, ear-piercings), fussy, or hunger states. Using the algorithm to predict the behavioral state of infants with reported colic. RESULTS: The cry-translation algorithm was 90.7% accurate for identifying pain cries, and achieved 71.5% accuracy in discriminating cries from fussiness, hunger, or pain. The ChatterBaby cry-translation algorithm overwhelmingly predicted that colic cries were most likely from pain, compared to fussy and hungry states. Colic cries had average pain ratings of 73%, significantly greater than the pain measurements found in fussiness and hunger (p < 0.001, 2-sample t test). Colic cries outranked pain cries by measures of acoustic intensity, including energy, length of voiced periods, and fundamental frequency/pitch, while fussy and hungry cries showed reduced intensity measures compared to pain and colic. CONCLUSIONS: Acoustic features of cries are consistent across a diverse infant population and can be utilized as objective markers of pain, hunger, and fussiness. The ChatterBaby algorithm detected significant acoustic similarities between colic and painful cries, suggesting that they may share a neuronal pathway.

Analysis of Preoperative Screening Criteria for Total Joint Arthroplasty in a Veteran Population.

BACKGROUND: This study describes the experience of patients who initially failed total joint arthroplasty preoperative screening criteria but were subsequently optimized and underwent surgery. METHODS: Time to optimization from the patients' initial clinic visit was recorded. Following surgery, patients' body mass index and lab work were tracked to determine whether they "relapsed" to their preoptimized state. Descriptive statistics determined (1) the length of time to meet screening criteria and (2) which screening criteria took the longest to optimize. RESULTS: Only 11 of 84 patients (13%) required greater than 1 year to meet criteria. Most patients (76%) "relapsed" to their previous nonqualifying status after surgery; however, this reversion did not contribute significantly to an increased rate of complication in short-term follow-up (P = .4298). CONCLUSION: Patients in this study were able to achieve preoperative screening criteria for total joint arthroplasty in less than 1 year. Relapsing after surgery does not appear to adversely affect clinical outcomes.

Activity and electrochemical properties: iron complexes of the anticancer drug triapine and its analogs.

Triapine (3-AP), is an iron-binding ligand and anticancer drug that is an inhibitor of human ribonucleotide reductase (RNR). Inhibition of RNR by 3-AP results in the depletion of dNTP precursors of DNA, thereby selectively starving fast-replicating cancer cells of nucleotides for survival. The redox-active form of 3-AP directly responsible for inhibition of RNR is the Fe(II)(3-AP)2 complex. In this work, we synthesize 12 analogs of 3-AP, test their inhibition of RNR in vitro, and study the electronic properties of their iron complexes. The reduction and oxidation events of 3-AP iron complexes that are crucial for the inhibition of RNR are modeled with solution studies. We monitor the pH necessary to induce reduction in iron complexes of 3-AP analogs in a reducing environment, as well as the kinetics of oxidation in an oxidizing environment. The oxidation state of the complex is monitored using UV-Vis spectroscopy. Isoquinoline analogs of 3-AP favor the maintenance of the biologically active reduced complex and possess oxidation kinetics that allow redox cycling, consistent with their effective inhibition of RNR seen in our in vitro experiments. In contrast, methylation on the thiosemicarbazone secondary amine moiety of 3-AP produces analogs that form iron complexes with much higher redox potentials, that do not redox cycle, and are inactive against RNR in vitro. The catalytic subunit of human Ribonucleotide Reductase (RNR), contains a tyrosyl radical in the enzyme active site. Fe(II) complexes of 3-AP and its analogs can quench the radical and, subsequently, inactivate RNR. The potency of RNR inhibitors is highly dependent on the redox properties of the iron complexes, which can be tuned by ligand modifications. Complexes are found to be active within a narrow redox window imposed by the cellular environment.

Object Tracking for a Smart City Using IoT and Edge Computing.

As the Internet-of-Things (IoT) and edge computing have been major paradigms for distributed data collection, communication, and processing, smart city applications in the real world tend to adopt IoT and edge computing broadly. Today, more and more machine learning algorithms would be deployed into front-end sensors, devices, and edge data centres rather than centralised cloud data centres. However, front-end sensors and devices are usually not so capable as those computing units in huge data centres, and for this sake, in practice, engineers choose to compromise for limited capacity of embedded computing and limited memory, e.g., neural network models being pruned to fit embedded devices. Visual object tracking is one of many important elements of a smart city, and in the IoT and edge computing context, high requirements to computing power and memory space severely prevent massive and accurate tracking. In this paper, we report on our contribution to object tracking on lightweight computing including (1) using limited computing capacity and memory space to realise tracking; (2) proposing a new algorithm region proposal correlation filter fitting for most edge devices. Systematic evaluations show that (1) our techniques can fit most IoT devices; (2) our techniques can keep relatively high accuracy; and (3) the generated model size is much less than others.

Rapid, Selective Extraction of Trace Amounts of Gold from Complex Water Mixtures with a Metal-Organic Framework (MOF)/Polymer Composite.

With the ever-increasing production of electronics, there is an ensuing need for gold extraction from sources other than virgin mines. Currently, there are no technologies reported to date that can effectively and selectively concentrate ultratrace amounts of gold from liquid sources. Here, we provide a blueprint for the design of several highly porous composites made up of a metal-organic framework (MOF) template and redox active, polymeric building blocks. One such composite, Fe-BTC/PpPDA, is shown to rapidly extract trace amounts of gold from several complex water mixtures that include wastewater, fresh water, ocean water, and solutions used to leach gold from electronic waste and sewage sludge ash. The material has an exceptional removal capacity, 934 mg gold/g of composite, and extracts gold from these complex mixtures at record-breaking rates, in as little as 2 min. Further, due to the high cyclability, we demonstrate that the composite can effectively concentrate gold and yield purities of 23.9 K.

MOF-Derived Cobalt Phosphide/Carbon Nanocubes for Selective Hydrogenation of Nitroarenes to Anilines.

Transition-metal phosphides have received tremendous attention during the past few years because they are earth-abundant, cost-effective, and show outstanding catalytic performance in several electrochemically driven conversions including hydrogen evolution, oxygen evolution, and water splitting. As one member of the transition-metal phosphides, Cox P-based materials have been widely explored as electrocatalyts; however, their application in the traditional thermal catalysis are rarely reported. In this work, cobalt phosphide/carbon nanocubes are designed and their catalytic activity for the selective hydrogenation of nitroarenes to anilines is studied. A high surface area metal-organic framework (MOF), ZIF-67, is infused with red phosphorous, and then pyrolysis promotes the facile production of the phosphide-based catalysts. The resulting composite, consisting of Co2 P/CNx nanocubes, is shown to exhibit excellent catalytic performance in the selective hydrogenation of nitroarenes to anilines. To the best of our knowledge, this is the first report showing catalytic activity of a cobalt phosphide in nitroarenes hydrogenation.

Contemporary management of advanced renal cell carcinoma.

Kidney cancer is the eighth most commonly diagnosed cancer in the United States, and nearly one-third of patients have locally advanced or metastatic disease at presentation. Historically, survival outcomes for patients with advanced disease have been poor. In recent years, several novel targeted agents have emerged for the management of advanced renal cell carcinoma that have changed treatment paradigms. At the same time, surgical therapy continues to have a critical role in the management of selected patients. Recent medical and surgical advances have improved the prognosis for patients with a diagnosis of advanced disease. This review provides an overview of the current treatment landscape for patients with advanced renal cell carcinoma.

Race and fall risk: data from the National Health and Aging Trends Study (NHATS).

OBJECTIVES: the objective of this study was to explore whether race-based difference in fall risk may be mediated by environmental and physical performance risk factors. METHODS: using data from a nationally representative longitudinal survey of 7,609 community-dwelling participants in the National Health and Aging Trends Study (NHATS), we evaluated whether racial differences in fall risk may be explained by physical performance level (measured by the Short Physical Performance Battery), mobility disability, physical activity level and likelihood of living alone. Multivariate Poisson regression and mediation models were used in analyses. RESULTS: in whites and blacks, the annual incidence of 'any fall' was 33.8 and 27.1%, respectively, and the annual incidence of 'recurrent falls' was 15.5 and 12.3%, respectively. Compared with whites, blacks had relative risks of 0.7 (95% confidence interval 0.6-0.8) and 0.6 (0.5-0.8) for sustaining any fall and recurrent falls, respectively, in adjusted analyses. Blacks had poorer performance on the SPPB (P < 0.001), higher levels of mobility disability (P < 0.001), similar levels of physical activity (P = 0.19) and were equally likely to live alone relative to whites (P = 0.77). Mediation analysis revealed that these risk factors collectively acted as suppressors and none of these factors accounted for the racial differences in fall risk observed. CONCLUSIONS: relative to whites, blacks were at 30 and 40% decreased risk of sustaining any fall and recurrent falls, respectively. This difference in risk remains unexplained.

Short term complications from transurethral resection of bladder tumor.

INTRODUCTION: The diagnosis and subsequent management of bladder cancer often involves transurethral resection of bladder tumor (TURBT). Risks of TURBT include perioperative complications such as bleeding, pain and perforation. We aimed to determine TURBT complication rates and risk factors in a contemporary series. MATERIALS AND METHODS: From 2002 to 2011, 505 patients underwent TURBT either for suspected bladder cancer or during follow up at a single institution. Baseline patient characteristics and complications within 2 weeks of surgery were extracted from the electronic medical record for all TURBTs. Patient and tumor characteristics were evaluated for associations with complication using univariate analysis. A multivariable logistic regression was fit to further examine associations between TURBT related characteristics and complication. RESULTS: A total of 910 TURBTs were performed on 505 patients. Overall complication rate was 8.1%. The most common complications were pain or spasm (3.0%), retention (2.8%), and infection (2.1%), and 0.5% of TURBTs had perforation. Over 85% of complications were Clavien-Dindo grade I or II. Forty-three patients had a complication after their first TURBT, while 25 had complications after subsequent TURBTs. Prior complication and single tumor, but not other patient or tumor-related characteristics, were associated with complication. Only prior complication (p < 0.01) was associated with subsequent complication after TURBT on multivariable analysis. CONCLUSIONS: Complication rate after TURBT is 8.1% and complications are generally not severe in nature. Prior short term complication is likely associated with subsequent complication. Further studies are needed to validate these results and determine patient groups most at risk for intraoperative and post TURBT complications.