Trajectory of adherence to home rehabilitation among older adults with hip fractures and cognitive impairment

This study aimed to identify different trajectories of adherence to home rehabilitation for older adults with hip fracture and cognitive impairment, to examine associations between different adherence trajectories and postoperative recovery outcomes, and to explore the predictors of adherence trajectories. Group-based trajectory modeling showed two adherence trajectories: low (39.06%) and high (60.94%) adherence. The high adherence group had better activities of daily living (β=11.77, p<.001), instrumental activities of daily living (β=0.56, p<.01), femoral muscular strength (β=3.35, p<.01) on the fractured side and quality of life (β=-0.81, p=.02) than the low adherence group. Participants who established exercise habits (OR=6.49, p<.01) and consulted a physical therapist (OR=4.29, p=.03) during hospitalization were more likely to be in the high adherence group.     

DARC: Deep adaptive regularized clustering for histopathological image classification

In recent years, deep learning as a state-of-the-art machine learning technique has made great success in histopathological image classification. However, most of deep learning approaches rely heavily on the substantial task-specific annotations, which require experienced pathologists’ manual labelling. As a result, they are laborious and time-consuming, and many unlabeled pathological images are difficult to use without experts’ annotations. To mitigate the requirement for data annotation, we propose a self-supervised Deep Adaptive Regularized Clustering (DARC) framework to pre-train a neural network. DARC iteratively clusters the learned representations and utilizes the cluster assignments as pseudo-labels to learn the parameters of the network. To learn feasible representations and encourage the representations to become more discriminative, we design an objective function combining a network loss with a clustering loss using an adaptive regularization function, which is updated adaptively throughout the training process to learn feasible representations. The proposed DARC is evaluated on three public datasets, including NCT-CRC-HE-100K, PCam and LC25000. Compared to the strategy of training from scratch, fine-tuning using the pre-trained weights of DARC can obviously boost the accuracy of neural networks on histopathological classification. The accuracy of using the network trained using DARC pre-trained weights with only 10% labeled data is already comparable to the network trained from scratch with 100% training data. The network using DARC pre-trained weights achieves the fastest convergence speed on the downstream classification task. Moreover, visualization through t-distributed stochastic neighbor embedding (t-SNE) shows that the learned representations are generalizable and discriminative.     

Back pain and treatment seeking among community-dwelling older adults: Findings from a population-based survey

This study explores the prevalence and factors associated with back pain and treatment seeking of older people. We used data from the Longitudinal Aging Study in India (LASI), 2017-18. A sample of 31,464 older adults aged 60 years and above was considered for this study. Chi-square test was used to find the significance level for bivariate associations. Additionally, Heckprobit selection model was employed to fulfill the objectives. Among 34% of the participants suffering from back pain, 46.2% used external application, followed by analgesics (40.8%) and therapy (6.6%). Older adults with higher education had a higher probability of seeking therapy than those with no or primary education [β:0.25; CI:0.03,0.48]. Participants from the highest wealth quintile had higher probability of seeking therapy than those from the lowest [β:0.41; CI:0.23,0.58]. The use of therapy, which is globally recommended first line of management for back pain, was least utilized and must be promoted.     

MicroRNA-21* regulates the prosurvival effect of GM-CSF on human eosinophils

Eosinophils are the principal effector cells of allergic inflammation, and hematopoietic cytokine granulocyte macrophage colony-stimulating factor (GM-CSF) is the primary cytokine that activates and prolongs the survival of eosinophils in local inflammatory sites by mediating anti-apoptotic activity in allergic inflammation. To investigate the immunopathological role of microRNA (miRNA) in allergic inflammation, we elucidated the regulatory mechanisms of miRNA on the GM-CSF-mediated in vitro survival in eosinophils. Eosinophils were purified from fresh human peripheral blood buffy coat fraction obtained from adult volunteer using microbead magnetic cell sorting. The apoptosis, viability and phosphorylation of extracellular signal-regulated kinase (ERK) were assessed by flow cytometry, and the expression of miRNA was analyzed using Agilent Human miRNA Microarray with Human miRNA Microarray Version 3 and real time RT-PCR. We have confirmed the increased in vitro viability of GM-CSF-treated eosinophils and upregulated expression of miRNA-21* (miR-21*), a complementary miRNA of miR-21, in GM-CSF-treated eosinophils. The transfection of pre-miR miR-21* precursor molecule could up-regulate the miR-21* expression, subsequently enhance the GM-CSF-activated ERK pathway and reverse the apoptosis of eosinophils, while anti-miR-21* inhibitor could down-regulate the miR-21* expression, suppress the GM-CSF-activated ERK pathway and enhance the apoptosis. Our results should shed light on the potential immunopathological role of miRNA-21* regulating the in vitro apoptosis of eosinophils and development of novel molecular treatment of allergic inflammation.     

Impact of including boys in the national school-based human papillomavirus vaccination programme in Singapore: A modelling-based cost-effectiveness analysis

Globally, gender-neutral Human Papillomavirus (HPV) vaccination programmes are gaining traction. Although cervical cancer remains the most prevalent, other HPV-related cancers are increasingly recognised as important, especially among men who have sex with men. We assessed if including adolescent boys in Singapore’s school-based HPV vaccination programme is cost-effective from the healthcare perspective.We adapted a World Health Organization-supported model, Papillomavirus Rapid Interface for Modelling and Economics, and modelled the cost and quality-adjusted life years (QALY) associated with vaccinating 13-year-olds with the HPV vaccine. Cancer incidence and mortality rates were obtained from local sources and adjusted based on the expected direct and indirect vaccine protection for various population subgroups at an 80 % vaccine coverage.Moving to a gender-neutral vaccination programme with a bivalent or nonavalent vaccine could avert 30 (95 % uncertainty interval [UI]: 20–44) and 34 (95 % UI: 24–49) HPV-related cancers per birth cohort, respectively. At a 3 % discount rate, a gender-neutral vaccination programme is not cost-effective. However, with a 1.5 % discount rate, which puts more value on long-term health gains from vaccination, moving to a gender-neutral vaccination programme with the bivalent vaccine is likely cost-effective, with an incremental cost-effectiveness ratio of SGD$19 007 (95 % UI: 10 164–30 633) per QALY gained.The findings suggest the need to engage experts to examine, in detail, the cost-effectiveness of gender-neutral vaccination programmes in Singapore. Issues of drug licensing, feasibility, gender equity, global vaccine supplies, and the global trend towards disease elimination/eradication should also be considered. This model provides a simplified method for resource-strapped countries to gain a preliminary estimate of the cost-effectiveness of a gender-neutral HPV vaccination programme before investing resources for further research.     

无预防性应用抗菌药物对感染高危患者PCI术后感染的影响

目的:探讨无预防性应用抗菌药物对感染高危患者经皮冠状动脉介入治疗(PCI)术后感染的影响。方法:将我院行PCI的195例患者,按是否有高龄(>70岁)、糖尿病等感染高危因素分为高危组(n=84)与非高危组(n=111),PCI围术期均无预防性应用抗菌药物。观察两组患者术后体温、白细胞变化和伤口愈合情况,对比两组患者PCI术后感染和疑似感染的发生率。结果:所有患者穿刺部位愈合良好,两组患者PCI术后感染发生率均为0%,高危组与非高危组PCI术后疑似感染发生率分别为30.95%和30.63%(P>0.05);高危组患者术后白细胞升高26例,无发热等临床症状。结论:感染高危患者PCI无预防性应用抗菌药物是可行的,PCI术后感染与预防性应用抗菌药物无关联性。严格无菌技术操作是减少PCI术后感染的关键。     

Quantification of tryptase-TIM-3 double-positive mast cells in human chronic periodontitis

ObjectivesMast cells (MCs) are implicated in the pathogenesis of allergic reactions and inflammatory conditions through the release of inflammatory mediators. So far limited attention has been given to the role of MCs in periodontitis. T cell immunoglobulin mucin domain (TIM)-3 is an immunomodulatory molecule and influences MC function. However, whether TIM-3 is expressed on MCs in the process of human periodontal disease has not been reported. Therefore, we identified MCs by toluidine blue staining and examined the expression of TIM-3 on tryptase-positive MCs in different severities of human chronic periodontitis using double-immunofluorescence staining in this study.Material and methodsA total of 83 human periodontal specimens were involved in this study, including healthy control tissues (n = 25), chronic moderate periodontitis (n = 28), and chronic severe periodontitis (n = 30). The gingival specimens were fixed in 10% buffered formalin, stained with haematoxylin and eosin for histopathology, with toluidine blue for MCs, and with double-immunofluorescence for identification of tryptase-TIM-3 double-positive MCs in gingival tissues.ResultsCompared with healthy controls, the score of gingival tissue inflammation was significantly increased in the chronic moderate periodontitis (P = 0.013) and chronic severe periodontitis (P < 0.0001), and the densities (cells/mm²) of tryptase-TIM-3 double-positive MCs were significantly increased in both the chronic moderate (P = 0.011) and severe periodontitis groups (P < 0.0001). However, compared with the chronic moderate periodontitis group, both the score of gingival tissue inflammation (P = 0.012) and the density of tryptase-TIM-3 double-positive MCs (P = 0.011) in gingival tissue were significantly increased in the severe periodontitis groups.ConclusionSignificantly increased number of tryptase-TIM-3 double-positive MCs had the similar tendency as the severity of periodontitis inflammation in human chronic periodontitis. Our data suggest that TIM-3 may have a role on MCs in human chronic periodontitis.     

半叶马尾藻多糖的分离纯化与光谱分析

本文对半叶马尾藻多糖采用水提醇沉法粗提，蛋白酶联合Sevag法去蛋白纯化，凝胶过滤柱层析分离得半叶马尾藻纯多糖的不同组分，溴化钾压片红外光谱测定和紫外光谱扫描鉴定分析。结果表明，SHP的苯酚-硫酸呈色反应呈阳性，茚三酮反应呈弱阳性，碘-碘化钾反应呈阴性，说明提取物为非淀粉性多糖。SHP的提取率为8．56％，总糖含量为90．96％。凝胶过滤柱层析结果表明，半叶马尾藻多糖中含有吡喃多糖、木聚糖、半乳糖、阿拉伯糖、葡萄糖、鼠李糖和果糖等。紫外扫描结果显示多糖几乎不含核酸和蛋白质；红外光谱显示SHP主要为吡喃多糖，并显示多糖分子结构中存在β2糖苷键，还存在α-D-半乳吡喃糖的特征吸收峰。     

Trajectories of BMI and internalizing symptoms: Associations across adolescence

The present study examined the longitudinal relations between body mass index (BMI) and internalizing symptoms among youth ages 10–17. Adolescents were selected from Statistics Canada's National Longitudinal Survey of Children and Youth (NLSCY). Latent growth curve modeling was used to investigate: 1) whether initial level (at age 10) or change in BMI were associated with changes in internalizing symptoms; and, 2) whether initial level or change in internalizing symptoms were associated with changes in BMI across adolescence. Associations between trajectories differed for boys and girls. Boys who started out with higher BMI experienced more internalizing symptoms across early- to mid-adolescence, but not more depressive symptoms at ages 16 and 17. For girls, there was a bidirectional relation between BMI and internalizing symptoms which persisted into later adolescence. Results suggest the bidirectional relation between BMI and internalizing symptoms is more salient for girls than for boys.     

An 8-week aerobic cycling intervention elicits improved gait velocity and biomechanics in persons with Parkinson’s disease

BackgroundIt is unknown if improvements in gait velocity following an aerobic cycling intervention are accompanied by improved gait biomechanics in individuals with Parkinson’s disease (PD) or if gait abnormalities are exaggerated in response to increased velocity.Research questionCan an 8-week aerobic cycling intervention elicit improvements in locomotor function in individuals with mild to moderate PD?MethodsA secondary analysis of data from a randomized clinical trial was conducted in individuals with mild to moderate idiopathic PD (N = 28). Participants were randomized to an aerobic cycling intervention (PD_ex, N = 14) consisting of 24 sessions at a targeted aerobic intensity of 60–80% of heart rate reserve or to a no intervention control group (PD_control, N = 14). Change in comfortable walking speed in addition to gait kinematics, kinetics, and spatiotemporal variables using motion capture were obtained at baseline and end of treatment (EOT).ResultsThe PD_ex group made significantly greater improvements in the primary outcome, change in comfortable gait velocity, from 0.86 ± 0.24 m/s at baseline to 1.00 ± 0.23 m/s at EOT compared to the PD_control group who declined from 0.91 ± 0.23 m/s at baseline to 0.80 ± 0.29 at EOT (P = 0.002). Improvements in gait velocity for the PD_ex group were accompanied by improvements in gait kinematics, kinetics, and spatiotemporal parameters, while the PD_control group demonstrated slight worsening in all gait parameters over the 8-week period.SignificanceThe 8-week moderate- to high-intensity cycling intervention elicited significantly greater improvements in gait velocity compared to the PD_control group. Increased gait velocity was accompanied by normalization of gait biomechanics, rather than an exaggeration of existing gait deviations. Aerobic cycling may be a viable treatment approach to improve gait velocity and gait biomechanics in individuals with mild to moderate PD and may mitigate declines in mobility.