Impaired Group Research Articles

Cerebral perfusion and amyloidosis in the oldest‐old

AbstractINTRODUCTIONIn a nested case–control study, we examined how cerebral perfusion relates to cognitive status and amyloid in the oldest‐old (i.e., 90 years of age and older).METHODSStudy participants included 113 dementia‐free older adults (76 cognitively normal [CN]; 37 cognitively impaired, no dementia [CIND]) from the 90+ Study (mean age = 92.9, SD = 2.4). We quantified regional perfusion from arterial spin labeling‐MRI (magnetic resonance imaging) and amyloid deposition from florbetapir‐positron emission tomography (PET) in a region comprising the posterior cingulate and precuneus (PCC+PCu), and additionally quantified perfusion in other regions important for cognitive decline (medial temporal lobe, inferior parietal lobe, and orbitofrontal cortex).RESULTSParticipants with CIND displayed lower perfusion in the PCC+PCu relative to participants who were CN, but there was no statistically significant difference between the groups in amyloid burden in this region. In addition, participants with CIND exhibited lower inferior parietal and higher orbitofrontal perfusion.DISCUSSIONCerebral perfusion is related to cognitive status in the oldest‐old independent of amyloidosis.Highlights Cerebral perfusion and amyloid positron emission tomography (PET) were measured in older adults: 90 years of age and older. Perfusion but not amyloid differed between cognitively impaired and normal groups. Frontal and parietal regions linked to cognitive decline had altered perfusion. Perfusion is related to cognitive status in the oldest‐old independent of amyloid.

Chronic renal impairment predicts oncological outcomes in UTUC patients undergoing RNU

Abstract Objective This study aims to explore the relationship between pre-existing renal impairment and oncological outcomes in upper tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy (RNU) using data from a multicentre international registry. Patients and methods Data on non-metastatic UTUC patients who underwent RNU were obtained from the Clinical Research Office of the Endourology Society Urothelial Carcinomas of the Upper Tract (CROES-UTUC) Registry. Patients were categorised into normal pre-operative renal function and chronic renal impairment (CKD) groups, with CKD defined as an estimated glomerular filtration rate below 60 mL/kg/1.73 m². Kaplan–Meier survival analysis was employed to investigate disease-free survival (DFS) and overall survival (OS). Multivariable Cox regression analysis was conducted to identify confounding variables. Results A total of 1393 patients diagnosed with UTUC who underwent RNU between 2014 and 2019 were analysed. 875 patients (62.4%) had normal renal function, whilst 528 patients (37.6%) had CKD prior to RNU. The two groups had similar proportions of bladder cancer history, comparable cardiovascular comorbidity, similar tumour stage, and comparable proportions receiving laparoscopic or robotic-assisted RNU. In multivariable cox regression analysis, CKD was found to be associated with inferior DFS (HR = 1.419; 95%CI = 1.060–1.898; p = 0.019). Upon multivariable analysis, pre-existing renal impairment and higher T stage (HR = 4.613; 95%CI = 1.829–4.712; p < 0.001) and the use of adjuvant chemotherapy (HR = 1.858; 95%CI = 1.229–2.807; p = 0.003) were also found to associate with worse DFS. Significant cardiovascular disease and higher T stage were associated with worse OS. Existing renal impairment at baseline did not have any significant associated with OS. Conclusion In this multicentre registry, preoperative chronic renal impairment was identified as an independent predictor of inferior DFS in patients undergoing RNU for non-metastatic UTUC. Preoperative CKD could serve as a clinical predictor of poorer oncological outcomes.

The Impact of Cognitive Impairment on Life Satisfaction in Older Adults: Examining the Double Mediating Roles of Neighborhood Satisfaction and Social Participation

ABSTRACT The environment plays an integral role in the lives of individuals with cognitive decline. This study analyzed data from the National Survey of Older Koreans (2020) (9,885 older Koreans). The results showed that cognitively impaired group had lower community environment satisfaction than the cognitively healthy group, which led to lower social participation and lower life satisfaction, and the double mediation effect was significant (B = −.001, p < .001). However, there was no direct effect of cognitive status on life satisfaction (B = .004, p = .759). The findings highlight the imperative for the development of neighborhood environments that foster social engagement among older adults experiencing cognitive decline.

Decreases in lung volume and lung height among ankylosing spondylitis patients with pulmonary function impairment: a 3D CT investigation

BackgroundRespiratory compromise among ankylosing spondylitis (AS) patients is characterized by restrictive pulmonary function, leading to the need for a meticulous assessment of lung volume. Compared with conventional pulmonary function tests (PFTs), CT-based lung volume measurements have superior accuracy and are crucial for understanding functional limitations in AS. This study investigated the correlation between CT lung volume and PFT parameters in AS patients, with a focus on changes in CT parameters and lung volume in patients with compromised pulmonary function.MethodsA total of 79 AS patients were included, and their full-length radiographs, thoracic CT scans, and PFT data were analysed. Specialized software was used to estimate the total and lobar lung volumes from the CT scans. The relationship between lung volume and PFT results was examined, and a multiple linear regression model was constructed to determine the influence of radiographic and CT parameters on total lung volume (TLV). Patients were classified into normal or impaired pulmonary function groups based on PFT outcomes, thus facilitating comparative analyses of radiographic and CT parameters and lung volumes between these groups.ResultsAmong the 79 AS patients, 19 had normal function, 4 had mixed dysfunction, and 56 experienced restrictive dysfunction. PFT parameters, including FVC, FEV1, TLC, FEV1%, and TLC%, showed varying correlations with TLV and individual lobe volume. Patients with compromised pulmonary function exhibited more pronounced spinal kyphosis and experienced a decline in TLV. Multiple regression analysis revealed that lung height and horizontal and vertical lung diameters independently influenced TLV. Notably, a decrease in lung height was observed in patients with impaired pulmonary function, whereas the horizontal and vertical diameters of the lungs remained stable.ConclusionsIn AS patients, TLV was found to be correlated with pulmonary function, particularly parameter such as FVC, FEV1, and TLC. A significant reduction in TLV was observed in those with impaired pulmonary function, with the primary contributing factor being a decrease in lung height.

Association of amyloid and cardiovascular risk with cognition: Findings from KBASE.

Limited research has explored the effect of cardiovascular risk and amyloid interplay on cognitive decline in East Asians. Vascular burden was quantified using Framingham's General Cardiovascular Risk Score (FRS) in 526 Korean Brain Aging Study (KBASE) participants. Cognitive differences in groups stratified by FRS and amyloid positivity were assessed at baseline and longitudinally. Baseline analyses revealed that amyloid-negative (Aβ-) cognitively normal (CN) individuals with high FRS had lower cognition compared to Aβ- CN individuals with low FRS (p<0.0001). Longitudinally, amyloid pathology predominantly drove cognitive decline, while FRS alone had negligible effects on cognition in CN and mild cognitive impairment (MCI) groups. Our findings indicate that managing vascular risk may be crucial in preserving cognition in Aβ- individuals early on and before the clinical manifestation of dementia. Within the CN and MCI groups, irrespective of FRS status, amyloid-positive individuals had worse cognitive performance than Aβ- individuals. Vascular risk significantly affects cognition in amyloid-negative older Koreans. Amyloid-negative CN older adults with high vascular risk had lower baseline cognition. Amyloid pathology drives cognitive decline in CN and MCI, regardless of vascular risk. The study underscores the impact of vascular health on the AD disease spectrum.

Effect of Age, Sex, Renal Impairment and Hepatic Impairment on the Safety, Pharmacokinetics and Pharmacodynamics of Asundexian.

Asundexian is a reversible and selective inhibitor of activated factor XI. It is currently under investigation for the prevention of secondary stroke in at-risk patients; these patients are often characterised by advanced age, impaired organ function and comorbidities. This article summarises results from three Phase I studies that investigated the effects of age and sex (study 1), chronic kidney disease including end-stage kidney disease (ESKD) on dialysis and dialysis-free days (study 2) and Child-Pugh A and B liver disease (study 3) on the safety, pharmacokinetics and pharmacodynamics of a single oral dose of asundexian 25mg. Study 1 was a multicentre, randomised, single-blind, placebo-controlled group-stratification design; study 2 was a single-centre, non-randomised, non-placebo-controlled, non-blinded group-stratification design; and study 3 had a non-randomised, non-blinded, non-placebo-controlled group-stratification design. Single doses of asundexian 25 mg were generally well tolerated in all three studies, with no asundexian-related bleeding events or treatment-emergent adverse events of special interest. Point estimates (geometric least squares [LS] means) (90% confidence intervals [CIs]) for the total asundexian area under the plasma concentration-time curve (AUC) for participants aged ≥65 to< 75 years versus ≥18 to <45 yearsand ≥75 to ≤80 years versus ≥18 to <45years were 1.257 (1.134-1.393) and 1.288 (1.158-1.433), respectively, and for females versus males, it was 1.084 (0.995-1.182). Point estimates (geometric LS means) (90% CIs) for unbound AUC in participants in estimated glomerular filtration rate (eGFR) categories G2 (60-89 mL/min/1.73 m2), G3 (30-59 mL/min/1.73 m2) and G4 (15-29 mL/min/1.73 m2) versus control were 1.003 (0.698-1.443), 0.791 (0.550-1.138) and 0.882 (0.606-1.285), respectively, and in participants with ESKD on dialysis-free day versus control was 0.597 (0.406-0.877). There was no effect of the dialysis procedure on the pharmacokinetics of asundexian. In participants deemed Child-Pugh class A and Child-Pugh class B, geometric LS means (90% CIs) for unbound AUC were 0.834 (0.597-1.164) and 1.143 (0.810-1.612), respectively, when compared to participants with normal liver function. Activated partial thromboplastin time (aPTT) was assessed as a pharmacodynamic variable of interest. Geometric mean maximum aPTT prolongation as a ratio to baseline after administration of asundexian 25 mg ranged from 1.45 to 1.55 in all age and sex groups, 1.49-1.59 in the control and eGFR G2 to G4 groups, 1.38-1.54 in the control and ESKD groups on dialysis and dialysis-free day and 1.38-1.89 in the healthy control and liver impairment groups. The effects of the investigated intrinsic factors on the exposure of asundexian were small and not considered clinically relevant. The impact of lower exposure in participants with ESKD requires further investigation. Pharmacodynamics were as expected. EudraCT 2022-000196-38 and 2020-000626-25.

A comprehensive evaluation on the associations between hearing and vision impairments and risk of all-cause and cause-specific dementia: results from cohort study, meta-analysis and Mendelian randomization study.

Epidemiological studies show inconsistent links between hearing/vision impairment and dementia risk. Using multisource data, we investigated how single or combined sensory impairments relate to risks of all-cause and specific types of dementia. We employed a triangulation approach combining three methodologies. We analyzed 90,893 UK Biobank (UKB) adults to explore single and joint effects of hearing and vision impairments on all-cause and Alzheimer's disease (AD), vascular dementia (VD) and non-AD non-VD (NAVD). A meta-analysis of prospective studies involving 937,908 participants provided stronger evidence. Finally, we conducted Mendelian randomization (MR) analysis using genome-wide association studies from UKB (361,194 participants) and FinnGen (412,181 participants) to validate relationships between sensory impairments and dementia occurrence. In the UKB cohort study, compared to participants with normal hearing, those in the mild and severe hearing impairment groups had progressively and significantly higher risk of all-cause dementia (mild: HR1.52, 95%CI 1.31-1.77; severe: HR1.80, 95%CI 1.36-2.38), AD (mild: HR1.63, 95%CI 1.30-2.04; severe: HR2.18, 95%CI 1.45-3.27), VD (mild: HR1.68, 95%CI 1.19-2.37; severe: HR1.47, 95%CI 1.22-1.78), and NAVD (mild: HR1.47, 95%CI 1.22-1.78; severe: HR1.98, 95%CI 1.43-2.75). Besides, vision impairment was associated with an increased risk of all-cause dementia (HR1.55, 95%CI 1.18-2.04) and NAVD (HR1.51, 95%CI 1.07-2.13). Furthermore, dual sensory impairment was associated with stepwise increased risks of all-cause and cause-specific dementia than single hearing or vision impairment. In the meta-analysis of 31 prospective cohort studies, risks of all-cause dementia and AD were elevated in participants with single hearing impairment (all-cause dementia: HR1.30, 95%CI 1.21-1.40; AD: HR1.30, 95%CI 1.21-1.40) and dual sensory impairment (all-cause dementia: HR1.63, 95%CI1.14-2.12; AD: HR 2.55, 95%CI 1.19-3.91), while single vision impairment only associated with higher risk of all-cause dementia (HR1.43, 95%CI 1.16-1.71) but not AD. Finally, the MR analysis revealed a significant association between hearing impairment and all-cause dementia (OR1.74, 95%CI 1.01-2.99), AD (OR1.56, 95%CI 1.09-2.23), and NAVD (OR1.14, 1.02-1.26), as well as vision impairment and NAVD (OR1.62, 95%CI 1.13-2.33). Our findings showed significant associations between hearing and vision impairments and increased risks of all-cause and cause-specific dementia. Standardized hearing and vision assessment and intervention should be emphasized in dementia prevention strategies.

The influence of alterations in the composition of intestinal microbiota on neurovascular coupling and cognitive dysfunction in individuals afflicted with CSVD

IntroductionAn expanding body of research has explored the crucial role of gut microbiota in cerebral small vessel disease (CSVD). The objective of this study is to investigate alterations in the gut microbiota structure among CSVD patients, to explore the correlation between differential taxonomic levels and the neurovascular coupling index as well as cognitive function and to elucidate the imaging and biomarkers of mild cognitive impairment (MCI) in CSVD. MethodsWe enrolled 104 patients with CSVD and 40 healthy controls (HC). Based on cognitive test scores, CSVD patients were categorized into a cognitively normal group (CSVD-NCI, n=61) and a mild cognitive impairment group (CSVD-MCI, n=43). Performing magnetic resonance imaging (MRI) scans, gut microbiota analysis, as well as clinical and neuropsychological assessments for all participants. Based on arterial spin labeling (ASL) and blood oxygen level-dependent (BOLD) imaging data, cerebral blood flow (CBF) and neural activity indices are computed. The coupling indices of CBF/mReHo, CBF/mfALFF, CBF/mALFF, and CBF/mDC are calculated to assess the whole-brain neurovascular coupling changes in patients with CSVD. ResultsSpecies annotation revealed differences in the composition at the phylum and genus levels among the HC, CSVD-NCI, and CSVD-MCI groups. Additionally, differential analysis using the Kruskal-Wallis test demonstrated specific dominant microbial communities in all three groups. The relative abundance of certain dominant microbial communities in CSVD patients exhibited correlations with neurovascular coupling and cognitive function. The combined assessment of Bacteroides genus and CBF/mDC proved effective in distinguishing between CSVD-NCI and CSVD-MCI, providing a novel non-invasive approach for the diagnosis of MCI in CSVD.

Orbital decompression improves visual function and macular blood perfusion status in patients with thyroid-related eye disease

BackgroundOrbital decompression surgery is a treatment option for Thyroid-associated Ophthalmopathy (TAO). However, its effects on visual function and macular perfusion status remain unclear. This study examined how orbital decompression surgery affects visual acuity and macular blood flow in TAO patients and the variation between these two factors.MethodsThis study involved cross-sectional and longitudinal analyses of 54 TAO patients, who were categorized into a normal vision group (n = 40) and an impaired vision group (n = 14) based on the presence of visual impairment before surgery (LogMAR BCVA &amp;gt;0.097). Among the participants, 20 underwent orbital decompression surgery (normal vision group: n = 13, impaired vision group: n = 7). BCVA and IOP were assessed at baseline in patients with TAO, and macular retinal blood perfusion indices were measured using OCTA. One month post-operatively, changes in these indices were compared between the two groups, and the correlation between visual acuity and macular perfusion indices was analyzed.ResultsThe LogMar BCVA in the visual impairment group was significantly worse than that in the normal vision group (p &amp;lt; 0.001), while the W-MVD was significantly lower (p = 0.01). In the visual impairment group, post-operative LogMar BCVA improved significantly (p = 0.038), and W-MVD increased significantly (p = 0.008) compared to baseline. However, there were no significant changes in LogMar BCVA, S-MVD, D-MVD, or W-MVD in the normal vision group from preoperative to postoperative assessments. A strong negative correlation was found between the changes in W-MVD and changes in LogMar BCVA in the eyes of the visual impairment group treated with orbital decompression (Pearson correlation coefficient, R = −0.812, p = 0.05).ConclusionThis study found that TAO patients with visual impairment had lower macular blood flow perfusion than those with normal vision. Endoscopic orbital decompression surgery was found to improve both the best-corrected visual acuity and macular blood flow perfusion in TAO patients with visual impairment, and the improvement in visual acuity was correlated with the improvement in macular blood flow perfusion.

Incremental value of biventricular strain in patients with severe aortic stenosis

Abstract Background Left ventricular global longitudinal (LVGLS) and right ventricular free wall strain (RVFWS) demonstrated separately prognostic value in patients with severe aortic stenosis (AS). However, studies evaluating combined assessment of LVGLS and RVFWS have shown contradictory results. Aim To explore the prognostic value of combining LVGLS and RVFWS in a large group of severe AS patients referred for transcatheter aortic valve implantation. Methods Patients were classified into three groups: preserved (LVGLS ≥15% AND RVFWS &amp;gt;20%), single-ventricle impaired (LVGLS &amp;lt;15% OR RVFWS ≤20%), or biventricular impaired strain group (LVGLS &amp;lt;15% AND RVFWS ≤20%). Cut-off values were based on previously published data and spline analyses. Endpoint was all-cause mortality. Results Of the 712 patients included (age 80±7 years, 53% men), 248 (35%) died. The single-ventricle impaired and biventricular impaired (vs. preserved) strain groups showed significantly lower 5-year survival rates (68%and 55%vs.77%, respectively, p&amp;lt;0.001; Figure 1). On multivariable analysis, single-ventricle impaired (HR 1.762; 95%CI:1.114-2.788; p=0.015) and biventricular impaired strain groups (HR1.920; 95%CI:1.134-3.250; p=0.015) were independently associated with all-cause mortality. These findings were confirmed by sensitivity analysis in patients with preserved LV ejection fraction (Figure 2). Conclusions In patients with severe AS, biventricular strain allows better risk stratification, even if LV ejection fraction is preserved.

Association between renal function impairment and body roundness index (BRI) in elderly hypertensive patients

Abstract Objective The purpose of this study was to explore the associations of renal function impairment and body roundness index (BRI) in elderly hypertensive patients. Methods This is a community-based observational and cross-sectional study.A total of 1482 elderly hypertensive patients from our center in 2021 were enrolled. Waist-to-hip ratio(WHR) , Body mass index(BMI) and BRI were calculated with validated formulas. According to tri quantile method of BRI level , the patients were divided into low , medium and high BRI groups. The incidence of renal function impairment in the three groups was compared to explore the associations of renal function impairment and BRI in elderly hypertensive patients. Result According to the estimated glomerular filtration rate (eGFR) level, the patients were divided into two groups: impaired renal function group and non impaired renal function group. 133 cases were included in the group with impaired renal function, and 1349 cases were included in the group without impaired renal function. The proportion of patients with impaired renal function was 8%, 497 were in the low BRI group, 491 in the medium BRI group, and 494 in the high BRI group. Comparing the incidence of renal function impairment in patients with different BRI levels, the results showed that the incidence of renal function impairment in patients with high BRI was higher than that in patients with low BRI (7.0%vs.11.5%,p=0.015). The results of binary logistic regression analysis showed that the risk of renal function impairment increased by 19% for each unit of BRI increase (95%CI 1.037-1.122,P=0.024). After adjusting for age, gender, blood lipid, smoking and drinking history, years of hypertension, diabetes, years of diabetes,and random blood glucose levels, the risk of renal function impairment in high BRI group was still significantly higher than low BRI group (OR=1.697,95%CI 1.031-2.794,P=0.038),shows that BRI is an independent risk factor for renal function impairment in elderly hypertension patients. The receiver operating characteristic curve (ROC) results show that the prediction ability of BRI in the whole population is better than that of BMI and waist circumference (WC), and the prediction ability of BRI in elderly female population is the best (AUC=0.569). Conclusion Increasing of BRI is correlated with the occurrence of renal function impairment in elderly hypertension patients, and has the best predictive value for renal function impairment in elderly women with hypertension.

The clinical characteristics and prognosis of patients with acute ST-segment elevation myocardial infarction complicated with impaired activity daily living

Abstract Background Previous studies have indicated that activities of daily living (ADL) can influence the prognosis of patients with acute myocardial infarction. The purpose of this study is to delineate the clinical characteristics, treatment regimens, and prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI) who have impaired ADL. Methods The data for this study were derived from a Health and Medical Big Data Superplatform, comprising a retrospective cohort of patients admitted to and discharged from 72 secondary and tertiary hospitals from 2010 to 2023. The inclusion criteria encompassed patients with a discharge diagnosis of STEMI.ADL prior to STEMI was evaluated using the Barthel index(BI),a widely used assessment tool for evaluating ADL.The patients' BI were obtained from their resident health records.Patients were categorized into two groups: ADL normal group and ADL impaired group. A comparative analysis was conducted between the two groups regarding clinical characteristics, treatment regimens, and prognosis. Results This study included 24,906 STEMI patients with normal ADL and 1,002 STEMI patients with impaired ADL. Baseline data revealed that patients in the ADL impaired group had a higher proportion of females (43.0% vs. 37.8%, p=0.001), were older (74.0[64.0,81.0] vs. 69.0[65.0,75.0], p&amp;lt;0.001), and had a higher proportion of Killip III and above (24.30% vs. 14.10%, p&amp;lt;0.001). Additionally, the ADL impaired group had a higher prevalence of comorbidities. In terms of treatment, the ADL impaired group had lower proportions of patients undergoing percutaneous coronary intervention (PCI) (43.8% vs. 65.3%, p&amp;lt;0.001) and primary PCI (PPCI) (36.4% vs. 55.1%, p&amp;lt;0.001). Additionally, the ADL impaired group exhibited lower utilization rates of antiplatelet drugs, ACEI/ARB, beta-blockers, ARNI, and statins, but higher rates of diuretics and cardiac glycosides. Regarding prognosis, the ADL impaired group had a higher in-hospital mortality rate (5.69% vs. 2.89%, p&amp;lt;0.001). The median follow-up time was 1,220 days. In the ADL impaired group, the rates of all-cause mortality (52.0% vs. 24.7%, p&amp;lt;0.001), cardiovascular mortality (37.3% vs. 17.3%, p&amp;lt;0.001), recurrent non-fatal myocardial infarction (11.1% vs. 8.30%, p=0.002), and recurrent stroke (11.9% vs. 8.66%, p=0.001) were higher. However, the rate of revascularization was lower in the ADL impaired group (6.69% vs. 9.20%, p=0.008), and the risk of cerebral hemorrhage showed no significant difference (1.00% vs. 0.81%, p=0.631). In a multivariate Cox regression analysis adjusting for age, gender, Killip, medical history, and treatment strategies, impaired ADL remained an independent risk factor for increased all-cause mortality (aHR 1.309, 95% CI: 1.195-1.434, p&amp;lt;0.001). Conclusions Impairment of ADL is associated with adverse clinical outcomes in patients with STEMI.Baseline characteristics of patientsMedications of patients

The clinical characteristics and prognosis of patients with acute non-ST-segment elevation myocardial infarction complicated with impaired activity daily living

Abstract Background Impaired activities of daily living (ADL) have been identified as an independent risk factor for cardiovascular diseases. This study aims to describe the clinical characteristics, treatment modalities, and prognosis of acute non-ST-segment elevation myocardial infarction (NSTEMI) patients with impaired ADL. Methods The data for this study were derived from a Health and Medical Big Data Superplatform, comprising a retrospective cohort of patients admitted to and discharged from 72 secondary and tertiary hospitals from 2010 to 2023. The inclusion criteria encompassed patients with a discharge diagnosis of NSTEMI.ADL prior to NSTEMI was evaluated using the Barthel index(BI),a widely used assessment tool for evaluating ADL.The patients' BI were obtained from patients’ resident health records, and patients were categorized into two groups: ADL normal and ADL impaired group. A comparative analysis was conducted between the two groups regarding clinical characteristics, treatment regimens, and prognosis. Results The study included 28,227 NSTEMI patients with normal ADL and 1,576 NSTEMI patients with impaired ADL. Baseline data revealed that the ADL impaired group had a higher proportion of females (49.4% vs. 43.2%, p &amp;lt; 0.001), older age (77.0 [69.0, 83.0] vs. 71.0 [66.0, 78.0], p &amp;lt; 0.001), and a higher proportion of patients with KILLIP III and above (25.86% vs. 17.44%, p &amp;lt; 0.001). Additionally, the ADL impaired group had a greater number of pre-existing comorbidities. Regarding treatment, the proportion of patients undergoing percutaneous coronary intervention (PCI) was significantly lower in the ADL impaired group (16.5% vs. 65.3%, p &amp;lt; 0.001). Moreover, the ADL impaired group showed lower utilization rates of antiplatelet agents, ACEI/ARBs, beta-blockers, ARNI, statins, and nitrates, while the utilization rates of diuretics and cardiac glycosides were higher. In terms of prognosis, the ADL impaired group exhibited a higher in-hospital mortality rate (6.03% vs. 3.35%, p &amp;lt; 0.001). During a median follow-up period of 876 days, the ADL impaired group had significantly higher rates of all-cause mortality (61.2% vs. 35.9%, p &amp;lt; 0.001) and cardiovascular mortality (41.8% vs. 24.8%, p &amp;lt; 0.001), while the rate of revascularization (6.69% vs. 9.20%, p = 0.008) was lower. There were no significant differences in the risks of recurrent non-fatal myocardial infarction (10.7% vs. 10.8%, p = 0.935), recurrent stroke (10.90% vs. 9.48%, p = 0.08), and hemorrhagic stroke (0.82% vs. 0.74%, p = 0.806). Following adjustment for age, gender, KILLIP classification, medical history, and treatment strategies in a multivariable Cox regression analysis, impaired ADL remained an independent risk factor for increased all-cause mortality (aHR 1.167, 95%CI: 1.091-1.249, p &amp;lt; 0.001). Conclusions The decline in ADL is significantly associated with adverse clinical outcomes among NSTEMI patients.Baseline characteristics of patientsMedications of patients

On prior visual experience in mental map navigation using allocentric and egocentric perspectives in the visually impaired.

Using new developments in the mental comparison task paradigm, this study addresses the question of the influence of prior visual experience in the natural use of mental perspective to achieve mental spatial tasks without any protocol-imposed perspective. During the experiment, 39 participants (11 early blind, 13 late blind, and 15 blindfolded-sighted) explored two corridor maps to memorise the spatial arrangement of 10 objects disposed along corridors. After the learning phase, several tasks addressing spatial memory and reasoning used in the mental spatial representation were performed. Blindfolded-sighted participants preferred an egocentric perspective, while the two visually impaired groups showed no overriding preference between egocentric and allocentric perspectives. Results showed a performance advantage for egocentric over allocentric perspectives, regardless of visual experience. Our results shed light on previous assumptions regarding cognitive mental map construction, suggesting the need to reflect on previous results and their dependence on imposed mental perspectives.

Plasma protein binding of arsenic species in acute promyelocytic leukemia patients and their relationships with hepatic and renal function

ABSTRACT Objectives Percentage protein binding (%PB) of arsenic species in acute promyelocytic leukemia (APL) patients treated with arsenic trioxide remains unclear. It can be different depending on the status of hepatic or renal function. Methods This study obtained steady-state blood samples from normal APL patients and those with hepatic or renal impairment. %PB of inorganic arsenic (iAs), monomethylarsonic acid (MMAV), and dimethylarsinic acid (DMAV) was determined by analyzing free and total plasma concentrations using ultrafiltration method by HPLC-HG-AFS. Results There is a linear relationship between free and total plasma concentrations for iAs (r2 = 0.952), MMAV (r2 = 0.603), and DMAV (r2 = 0.945). For patients with normal hepatic and renal function, mean %PB was as follows: iAs at 26.7 ± 14.3%, MMAV at 53.3 ± 11.9%, and DMAV at 24.7 ± 7.8%. %PB decreased in patients with renal impairment, with MMAV and DMAV showing statistically significant differences (p < 0.05 for MMAV, p < 0.01 for DMAV). No significant differences in %PB between normal and hepatic impairment group were observed. Conclusion Free arsenic species fraction can be estimated by total concentration. DMAV and iAs present low %PB, while MMAV exhibits a relatively high %PB in plasma. Level of %PB is more likely to be affected by renal function and age.

Poor oral status at stroke onset negatively affects activities of daily living at discharge: A propensity-score analysis

Background & AimsPoor oral status during stroke recovery can cause malnutrition, which can markedly affect activities of daily living and prevent patients from being discharged home. Therefore, prompt evaluation and treatment of oral disorders immediately after stroke is essential. This study aimed to examine the impact of poor oral status on the post-stroke recovery of independence in activities of daily living and home discharge. MethodsThis single-center retrospective observational study included 137 patients with acute stroke, divided into two groups based on their Oral Assessment Guide (OAG) scores: the normal OAG group (score=8) and the impaired OAG group (scores ≥9). Propensity-score matching was performed to minimize confounding variables. The χ2 test and odds ratios were used to compare the percentage of independence and home discharges between the two groups. ResultsThe normal and impaired OAG groups exhibited no difference in neurological severity or nutritional intake after matching. The percentage of patients achieving independence in activities of daily living in the normal OAG group (86.8%) was significantly higher than that in the impaired OAG group (65.8%) (p=0.03, odds ratio [OR] 0.29, 95% confidence interval [CI] 0.09–0.92). Conversely, no significant difference in the percentage of patients discharged home was found (p=0.15, OR 0.49, 95%CI 0.19–1.29). ConclusionsThis study found that poor oral status after stroke onset was an independent factor affecting independence in activities of daily living at discharge, irrespective of neurological severity and dietary intake.

Multiple sclerosis subgroups: Data-driven clusters based on patient-reported outcomes and a large clinical sample.

While standard clinical assessments provide great value for people with multiple sclerosis (PwMS), they are limited in their ability to characterize patient perspectives and individual-level symptom heterogeneity. To identify PwMS subgroups based on patient-reported outcomes (PROs) of physical, cognitive, and emotional symptoms. We also sought to connect PRO-based subgroups with demographic variables, functional impairment, hypertension and smoking status, traditional qualitative multiple sclerosis (MS) symptom groupings, and neuroperformance measurements. Using a cross-sectional design, we applied latent profile analysis (LPA) to a large database of PROs; analytic sample N = 6619). We identified nine distinct MS subtypes based on PRO patterns. The subtypes were primarily categorized into low, moderate, and high mobility impairment clusters. Approximately 70% of participants were classified in a low mobility impairment group, 10% in a moderate mobility impairment group, and 20% in a high mobility impairment group. Within these subgroups, several unexpected patterns were observed, such as high mobility impairment clusters reporting low non-mobility impairment. The present study highlights an opportunity to advance precision medicine approaches in MS. Combining PROs with data-driven methodology allows for a cost-effective and personalized characterization of symptom presentations. that can inform clinical practice and future research designs.

The prognosis and related factors impacting renal response in newly diagnosed multiple myeloma patients with renal impairment

Objective: To investigate the prognosis and related factors impacting renal response in newly diagnosed multiple myeloma (NDMM) patients with renal impairment. Methods: A total of 375 NDMM patients diagnosed at the Department of Hematology, the First Affiliated Hospital of Nanjing Medical University from August 2012 to April 2022 were retrospectively recruited. Patients were categorized into non-renal impairment group(n=273) and renal impairment group (n=102) according to renal function at initial diagnosis. All patients received≥2 cycles of bortezomib-based induction chemotherapy after admission. The hematological response included stringent complete response (sCR), complete response (CR), very good partial response (VGPR), partial response (PR) and stable disease (SD). The renal responses were defined as CR, PR, minor response (MR) and non-response (NR). General clinical data of the patients were collected, and patients were followed up by telephone. The follow-up deadline was December 3, 2022, and the median follow-up time [M (Q1, Q3)] was 42 (22, 61) months. Kaplan-Meier analysis was used to plot the survival curve. The log-rank test was utilized for inter-group comparisons. Multivariate logistic regression modeling facilitated the exploration of associated factors impacting renal response. Results: In the renal impairment group, there were 68 males and 34 females with a median age [M (Q1, Q3)] of 64 (58, 69) years. In the non-renal impairment group, there were 149 males and 124 females with a median age of 62 (54, 68) years. Compared with the renal impairment group, the age, lactate dehydrogenase and 24-hour urinary protein quantity were increased, the proportion of patients with light chain M protein and the proportion of patients at the DS-Ⅲ stage, ISS-Ⅲ stage and R-ISS-Ⅲ stage were higher, the hemoglobin level and the proportion of patients receiving autologous hematopoietic stem cell transplantation were lower in the renal impairment group (all P<0.05). In 102 patients with renal impairment, renal responses of CR, PR, MR and NR were obtained in 53 (52.0%), 8 (7.9%), 18 (17.6%), 23 (22.5%) patients, respectively, and the overall response rate was 77.5% (79/102). Kaplan-Meier survival curve revealed that the median progression-free survival (PFS) was 24.0 (95%CI: 18.3-29.7) months in the renal impairment group, which was shorter than 31.0 (95%CI: 24.7-37.3) months in the non-renal impairment group (P=0.003). The median overall survival (OS) was 46.0 (95%CI: 36.5-55.5) months in the renal impairment group, which was shorter than 79.0 (95%CI: 59.9-98.1) months in the non-renal impairment group (P=0.002). Among the renal impairment group, patients with renal response of less than PR exhibited a median PFS of 19.0 (95%CI: 9.7-28.3) months, which was shorter than 28.0 (95%CI: 21.4-34.5) months for those achieving PR or better (P=0.048). The median OS was 31.0 (95%CI: 23.5-38.5) months in renal response with less than PR group, which was also worse than 57.0 (95%CI: 42.8-71.2) months for those who achieved PR or better (P=0.003). The results of multivariate logistic regression showed that hematological response achieving VGPR or better was a factor associated with renal response achieving PR (OR=4.20, 95%CI: 1.20-14.68, P=0.025). Conclusions: The prognosis of NDMM patients with renal impairment is poor. The hematological response with VGPR or better is related to the renal response achieving PR.

A multimodal learning machine framework for Alzheimer’s disease diagnosis based on neuropsychological and neuroimaging data

Alzheimer’s disease (AD) is the most prevalent form of dementia, with no current cure. Early screening and intervention are vital. In multimodal AD data, besides neuroimaging dimensions, neuropsychological tests based on cognitive domains also provide the clinical information for diagnosing AD. However, previous multimodal methods often fuse these neuropsychological test scores with other data, losing the rich clinical details inherent in each test, including videos, speech, images, and text. To address this, we propose a novel framework with an entropy-based polynomial dimension expansion function that restores this critical information by accurately calculating the optimal polynomial degree. Additionally, the proposed framework offers a series of cognitive-based Extreme Learning Machine (ELM) models to better utilize the detailed clinical insights from neuropsychological tests, reducing diagnostic redundancy and noise. Finally, we design a boosting ensemble strategy that combines diagnostic models from various dimensions and cognitive domains, automatically optimizing weights to enhance diagnostic accuracy. Tested on the Alzheimer’s Disease Neuroimaging Initiative (ADNI) dataset, our approach achieves over 98% accuracy and F1 scores, with no observed bias between mild cognitive impairment (MCI) and AD groups. Therefore, our framework can offer clinicians more logical recommendations for diagnosing and managing the disease.

The Relationship Between Poor Sleep and Memory Impairment Among Shift Nurses in China: A Cross-Sectional Study.

Many shift nurses experience poor sleep quality, and the effect on nurses' cognitive function remains unclear. The study aims to investigate sleep status and explore its association with cognitive function. This descriptive cross-sectional study was conducted in a tertiary care hospital in Fujian, China between March and September 2022. By convenience sampling method, 588 shift nurses participated in this study. The Pittsburgh Sleep Quality Index (PSQI) and Bergen Shift Work Sleep Questionnaire (BSWSQ) were used to assess sleep quality, while the Chinese version of Ascertain Dementia-8 (AD-8) was used to evaluate cognitive function. A PSQI score ≤7 is classified as good sleep quality, and a score >7 indicates poor sleep quality. An AD-8 score≥ 2 is considered indicative of memory impairment. Multivariate logistic regression analysis was conducted to explore the association between sleep status and memory impairment. A total of 310 (52.6%) participants presented poor sleep quality. Among them, 52.2% of participants had day shift-related sleep problems, 45.9% had evening shift-related sleep problems, 61.9% had night shift-related sleep problems, and 15.0% reported rest-day/vacation-related sleep problems. The prevalence of poor sleep quality and each shift-related sleep problem in the memory impairment group were higher than in the normalmemory group (P<0.05). Multivariate logistic regression analysis indicated that poor sleep quality (OR=2.073, 95% CI: 1.398~3.072), evening shift-related sleep problems (OR=1.707, 95% CI: 1.028~2.835), night shift-related sleep problems (OR=1.859, 95% CI:1.104~3.129), and rest-day/vacation-related sleep problems (OR=2.069, 95% CI:1.170~3.659) was significantly associated with memory impairment. This study highlights the prevalence of poor sleep quality among clinical nurses and identifies poor sleep quality and shift-related sleep problems (excluding day shift) as risk factors for memory impairment. Nurse managers should prioritize sleep quality and focus on cognitive function to enhance nurses' occupational health.