Disability Rates Research Articles

Shear force-ROS sequential responsive drug delivery system for improving cerebral thrombosis microcirculation and neurological function.

The ischemic strokes seriously threaten human health with high incidence and disability rates. Cerebral embolism and impaired brain function are the two major clinical features of this disease. Therefore, rapid restoration of cerebral blood supply and synchronous improvement of impaired neurological function is the key to treating strokes. Herein, based on the microenvironment of cerebral thrombosis and pathological characteristics of damaged neurons, we constructed a shear force and reactive oxygen species (ROS) dual-responsive system (UK@Fuc/CDPC-PTPCS) for sequential targeted delivery of thrombolytic agent urokinase (UK) and neuroprotective drug cytosolic choline (CDPC). Results proved that after intravenous administration, UK@Fuc/CDPC-PTPCS can quickly locate to cerebral thrombosis site via the active recognition capability of fucoidan (Fuc) to P-selectin overexpressed on activated platelets. Subsequently, the sharply increased blood shear force separated the core-shell structure by breaking the host-guest interaction of β-cyclodextrin (β-CD), so the UK loaded in the shell was first released to rapid thrombolysis and then restored cerebral blood supply. Afterward, the stroke homing peptide (SHp) modified CDPC-PTPCS core actively recognized ischemic damaged neuronal cells. Then high intracellular ROS triggered CDPC release at specific sites to exert neuroprotective effects. This study offered a new therapeutic strategy for ischemic stroke.

Current Status of Research on Nanomaterials Combined with Mesenchymal Stem Cells for the Treatment of Ischemic Stroke.

Ischemic stroke (IS) is a disease with high mortality and disability rates worldwide and is a serious threat to patient health. Owing to the narrow therapeutic window, effective treatments during the recovery period are limited. However, in recent years, mesenchymal stem cells (MSCs) have attracted attention and have shown therapeutic potential in IS treatment because of their abilities to home and secrete multiple bioactive substances and potential for differentiation and substitution. The therapeutic mechanisms of MSCs in IS include the regulatory effects of MSCs on microglia, the dual role of MSCs in astrocytes, how MSCs connect innate and adaptive immunity, the secretion of cytokines by MSCs to counteract apoptosis and MSC apoptosis, the promotion of angiogenesis by MSCs to favor the restoration of the blood‒brain barrier (BBB), and the potential function of local neural replacement by MSCs. However, the low graft survival rate, insufficient homing, poor targeting, and inability to achieve directional differentiation of MSCs limit their wide application. As an approach to compensate for the shortcomings of MSCs, scientists have used nanomaterials to assist MSCs in homing, survival and proliferation. In addition, the unique material of nanomaterials adds tracking, imaging and real-time monitoring to stroke treatment. The identification of effective treatments for stroke is urgently needed; thus, an understanding of how MSCs treat stroke and further improvements in the use of nanomaterials are necessary.

Integrative multi-omics approach using random forest and artificial neural network models for early diagnosis and immune infiltration characterization in ischemic stroke

BackgroundIschemic stroke (IS) is a significant global health issue, causing high rates of morbidity, mortality, and disability. Since conventional Diagnosis methods for IS have several shortcomings. It is critical to create new Diagnosis models in order to enhance existing Diagnosis approaches.MethodsWe utilized gene expression data from the Gene Expression Omnibus (GEO) databases GSE16561 and GSE22255 to identify differentially expressed genes (DEGs) associated with IS. DEGs analysis using the Limma package, as well as GO and KEGG enrichment analyses, were performed. Furthermore, PPI networks were constructed using DEGs from the String database, and Random Forest models were utilized to screen key DEGs. Additionally, an artificial neural network model was developed for IS classification. Use the GSE58294 dataset to evaluate the effectiveness of the scoring model on healthy controls and ischemic stroke samples. The effectiveness of the scoring model was evaluated through AUC analysis, and CIBERSORT analysis was conducted to estimate the immune landscape and explore the correlation between gene expression and immune cell infiltration.ResultsA total of 26 significant DEGs associated with IS were identified. Metascape analysis revealed enriched biological processes and pathways related to IS. 10 key DEGs (ARG1, DUSP1, F13A1, NFIL3, CCR7, ADM, PTGS2, ID3, FAIM3, HLA-DQB1) were selected using Random Forest and artificial neural network models. The area under the ROC curve (AUC) for the IS classification model was found to be near 1, indicating its high accuracy. Additionally, the analysis of the immune landscape demonstrated elevated immune-related networks in IS patients compared to healthy controls.ConclusionThe study uncovers the involvement of specific genes and immune cells in the pathogenesis of IS, suggesting their importance in understanding and potentially targeting the disease.

Evaluation and comparison of disability and functioning of low-risk pregnant women in 2nd and 3rd trimester using the world health organization disability assessment schedule 2.0

Background: Pregnancy is a physiological phenomenon where there is progressive anatomical, physiological, and biochemical change not only confined to the genital organs but also to all the systems of the body. There is a lack of knowledge in the field of functioning and disability among women with low-risk pregnancy without severe complications, and the condition that can lead to limitation in activity and restriction of participation. Considering the lack of research and the fact that the physiological changes of pregnancy can impact negatively on women’s functioning, the purpose of this study was to evaluate disability and functioning of low-risk pregnancy and its associated factors using a specified diagnosed tool developed by the World Health Organization (WHO). Aims and Objectives: The aim of the study was to evaluate disability and functioning of low risk pregnancy using the WHO disability assessment schedule 2.0 (WHODAS 2.0). Materials and Methods: This is an observational hospital-based prospective study, 140 women aged 18–35 year with low-risk pregnancy were interviewed first in 2nd trimester using WHODAS 2.0 questionnaire which was followed by 2nd interview in 3rd trimester with a minimum gap of 8 weeks and comparison was done between both trimester. Results: Higher level of disability observed in cognition in 2nd trimester (P=0.009) while mobility and life activities domain were high in 3rd trimester (P=0.01 and P=0.027). Self-care domain had P=0.008 which was statistically significant with increasing level of difficulty in self-care as pregnancy advances. Getting along (P=0.005), participation (0.042) indicating greater difficulty as pregnancy progresses. Conclusion: The findings showed that even in a low risk pregnancy, functioning can be affected in different domains. The identification of impairments to functioning could enable improvement in care. Longitudinal studies involving the first trimester and postpartum are necessary to gain insight into women’s disability and functioning during the pregnancy puerperal period.

Emerging Neuroprotective Strategies: Unraveling the Potential of HDAC Inhibitors in Traumatic Brain Injury Management.

Traumatic brain injury (TBI) is a significant global health problem, leading to high rates of mortality and disability. It occurs when an external force damages the brain, causing immediate harm and triggering further pathological processes that exacerbate the condition. Despite its widespread impact, the underlying mechanisms of TBI remain poorly understood, and there are no specific pharmacological treatments available. This creates an urgent need for new, effective neuroprotective drugs and strategies tailored to the diverse needs of TBI patients. In the realm of gene expression regulation, chromatin acetylation plays a pivotal role. This process is controlled by two classes of enzymes: histone acetyltransferase (HAT) and histone deacetylase (HDAC). These enzymes modify lysine residues on histone proteins, thereby determining the acetylation status of chromatin. HDACs, in particular, are involved in the epigenetic regulation of gene expression in TBI. Recent research has highlighted the potential of HDAC inhibitors (HDACIs) as promising neuroprotective agents. These compounds have shown encouraging results in animal models of various neurodegenerative diseases. HDACIs offer multiple avenues for TBI management: they mitigate the neuroinflammatory response, alleviate oxidative stress, inhibit neuronal apoptosis, and promote neurogenesis and axonal regeneration. Additionally, they reduce glial activation, which is associated with TBI-induced neuroinflammation. This review aims to provide a comprehensive overview of the roles and mechanisms of HDACs in TBI and to evaluate the therapeutic potential of HDACIs. By summarizing current knowledge and emphasizing the neuroregenerative capabilities of HDACIs, this review seeks to advance TBI management and contribute to the development of targeted treatments.

"Jumping on the Blood Pressure Bandwagon": Nurse, GP, and Patient Perspectives of a General Practice Nurse-Led Hypertension Management Intervention.

To explore the perceptions and experiences of general practice nurses, general practitioners, and patients who participated in a nurse-led intervention to improve blood pressure control. Given the impact of hypertension on rates of premature death and disability, it is important that interventions be evaluated to reduce blood pressure. A key component of such evaluation is understanding the experiences of participants and clinicians. Understanding these experiences can provide insight into acceptability and feasibility that informs future research and implementation. Qualitative descriptive study within a mixed methods project. Semi-structured interviews were conducted post-intervention with six patients, five nurses, and three general practitioners. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. The COREQ checklist guided reporting. Three themes around the need for change, navigating change, and sustaining change were revealed. In highlighting the need for change, participants recognized that it was time to actively work toward improved blood pressure control. In navigating change, general practice nurses were perceived as ideally placed to communicate risks around uncontrolled blood pressure and support lifestyle change. The final theme, sustaining change revealed the feasibility of the intervention in practice, however, clinician participants identified that appropriate funding is required to ensure sustainability. Nurse-led intervention to improve blood pressure control in general practice is feasible in practice and acceptable to patients. This highlights an opportunity for nurses to play a more proactive role in hypertension management within general practice. To ensure sustainability, however, issues such as funding, teamwork, and collaboration need to be addressed. Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN12618000169246.

The Role of Induced Pluripotent Stem Cells in the Treatment of Stroke.

Stroke is a neurological disorder with high disability and mortality rates. Almost 80% of stroke cases are ischemic stroke, and the remaining are hemorrhagic stroke. The only approved treatment for ischemic stroke is thrombolysis and/or thrombectomy. However, these treatments cannot sufficiently relieve the disease outcome, and many patients remain disabled even after effective thrombolysis. Therefore, rehabilitative therapies are necessary to induce remodeling in the brain. Currently, stem cell transplantation, especially via the use of induced pluripotent stem cells (iPSCs), is considered a promising alternative therapy for stimulating neurogenesis and brain remodeling. iPSCs are generated from somatic cells by specific transcription factors. The biological functions of iPSCs are similar to those of embryonic stem cells (ESCs), including immunomodulation, reduced cerebral blood flow, cerebral edema, and autophagy. Although iPSC therapy plays a promising role in both hemorrhagic and ischemic stroke, its application is associated with certain limitations. Tumor formation, immune rejection, stem cell survival, and migration are some concerns associated with stem cell therapy. Therefore, cell-free therapy as an alternative method can overcome these limitations. This study reviews the therapeutic application of iPSCs in stroke models and the underlying mechanisms and constraints of these cells. Moreover, cell-free therapy using exosomes, apoptotic bodies, and microvesicles as alternative treatments is discussed.

Study on the Expression and Potential Function of LncRNA in Peripheral Blood of Patients with Ankylosing Spondylitis.

Ankylosing spondylitis (AS) is an autoimmune disease that has the characteristics of difficult early diagnosis and a high disability rate. The objective of this study was to further explore the possible mechanism and potential function of lncRNA in AS. We used lncRNA microarray technology to detect the expression of lncRNA and mRNA in patients with active AS, stable patients, and healthy controls (HC). Afterward, bioinformatics analysis was conducted on differentially expressed genes. Seven differentially expressed lncRNAs were screened out for real-time fluorescent quantitative PCR (RT-qPCR), combined with various clinical indicators for correlation analysis, and the receiver operating characteristic (ROC) curve was used to analyze the potential of lncRNA as a diagnostic marker for AS. The results showed that the expression levels of NR-037662 and ENST00000599316 in the AS subgroups were significantly higher than those in the HC group, while the expression levels of ENST00000577914 and ENST00000579003 were lower than those in the HC group. The expression levels of NR-003542 and ENST00000512051 in the ASA group were significantly higher than those in the ASS and HC groups, while NR-026756 was just the opposite. Spearman's correlation analysis showed that the expression level of NR-003542 was positively correlated with Bath Ankylosing Spondylitis Functional Index (BASFI), Erythrocyte Sedimentation Rate (ESR), and high sensitivity C-Reactive Protein (hsCRP). The expression level of NR-026756 was negatively correlated with the Bath Ankylosing Spine Inflammatory Disease Activity Index (BASDAI), BASFI, ESR, hsCRP, and globulin (GLOB). In addition, it was also found that the ROC curve analysis of the 4 lncRNAs between the AS group (ASA group and ASS group) and the HC group were statistically significant, and the area under the curve (AUC) of NR-037662, ENST00000599316, ENST00000577914, and ENST00000579003 was 0.804, 0.812, 0.706, and 0.698, respectively. It was found that these differentially expressed lncRNAs of AS may be involved in the occurrence and development of the disease. Among them, NR-037662, ENST00000599316, ENST00000577914, and ENST00000579003 might have the potential to become AS diagnostic molecular markers. Moreover, NR -003542, ENST00000512051, and NR-026756 might have the potential to be indicators of disease activity.

Challenges of delay in diagnosis and high disability rate among newly diagnosed leprosy patients in Karachi, Pakistan

Challenges of delay in diagnosis and high disability rate among newly diagnosed leprosy patients in Karachi, Pakistan

Analysis of the effect of range of motion exercises on the quality of life of post-stroke patients at royal prima hospital Medan in 2024

Stroke is a severe medical condition that occurs due to the interruption of blood supply to the brain, either through blockage (ischemic stroke) or rupture of blood vessels (hemorrhagic stroke). With more than 15 million cases each year worldwide, stroke is a leading cause of disability and death, with a significant impact on patients' quality of life. In Indonesia, the prevalence of stroke is very high, especially among adult patients, which contributes to the high mortality and disability rates. This study aims to evaluate the effect of Range of Motion Exercises on the physical condition and quality of life of post-stroke patients at the Rehabilitation Polyclinic of Royal Prima Hospital Medan. Using a correlational descriptive research design with the One Group Pretest-Posttest approach, this study involved 30 respondents who underwent a range of motion exercises. The results of the analysis showed that before the intervention, the majority of patients were in the poor quality of life category. However, after undergoing a rehabilitation program, there was a significant improvement in the patient's quality of life, where 50% of the respondents reported an excellent quality of life. This study indicates that range of motion exercises are effective in improving the quality of life of stroke patients, which has the potential to make an essential contribution to the development of stroke rehabilitation programs in Indonesia.

Differential analysis of microRNAs in plasma exosomes in patients with cerebral ischemic stroke.

The high incidence, disability, mortality, and recurrence rates of cerebral infarction impose a heavy burden on both the Chinese and global populations. It is essential for the early diagnosis, prevention, and protection against brain cell injury. To identify differentially expressed microRNAs (miRNAs) in plasma exosomes of patients with cerebral ischemic stroke, determine relevant biomarkers, and explore their potential signaling pathways. High-throughput sequencing was used to detect the expression of plasma exosomal miRNAs in patients with cerebral ischemic stroke and in a control group. Gene Ontology, Kyoto Encyclopedia of Genes and Genomes enrichment, and target gene network analyses were performed to investigate the target genes and signaling pathways of the differentially expressed miRNAs. The sequencing results identified 95 differentially expressed miRNAs, with 40 upregulated and 55 downregulated miRNAs. Among these, hsa-miR-1303, hsa-miR-125b-1-3p, and hsa-miR-548ab were significantly upregulated in the stroke group and downregulated in the normal control group, whereas hsa-miR-1289 was downregulated in the stroke group and upregulated in the normal group. Gene Ontology, Kyoto Encyclopedia of Genes, and genomes enrichment analyses indicated that the differentially expressed miRNAs and their target genes were mainly concentrated in the PI3K-AKt, mitogen-activated protein kinase, calcium, Ras, Rap1, and cAMP signaling pathways. The expression of plasma exosomal hsa-miR-1303, hsa-miR-125b-1-3p, and hsa-miR-1289 was significantly different in stroke patients than in the control group. These miRNAs may be involved in various signaling pathways related to cerebral infarction, providing a reference for further experimental research.

Photo-controlled multifunctional hydrogel for photothermal sterilization and microenvironment amelioration of infected diabetic wounds

Diabetic foot ulcers are linked to a high disability rate, with no effective treatment currently available. Addressing infection, reducing oxidative stress, and safely managing chronic inflammation remain major challenges. In this study, a composite hydrogel dressing was developed using natural substances or clinically approved components (dopamine, D-alpha-tocopheryl polyethylene glycol succinate, and rhein). Upon near-infrared laser irradiation, the composite system rapidly heats and solidifies into a gel with photothermal antibacterial properties. Additionally, the decomposition of hydrogen peroxide releases oxygen, alleviating wound hypoxia. The hydrogel exhibited strong bactericidal activity against multiple bacterial strains. Without laser irradiation, the hydrogel effectively scavenged various free radicals and intracellular reactive oxygen species, restoring redox balance. Furthermore, it significantly reduced the expression of inflammatory cytokines, including interleukin-6 and interleukin-1β. In a diabetic mouse wound model infected with S. aureus, the mild photothermal therapy, combined with the antibacterial action of rhein, effectively managed bacterial infections, reduced inflammation, and promoted wound healing. Consequently, the photo-controlled therapeutic approach, offering antibacterial, antioxidant, and anti-inflammatory effects, holds promise for the effective treatment and management of infected diabetic wounds.

The epidemiologic associations of food availability with national incidence and disability rates of idiopathic pediatric epilepsy

BackgroundThe epidemiology of idiopathic pediatric epilepsy globally continues to be defined. To date there has been no evaluation of how national food availability may associate with the incidence and disability-adjusted life years (DALYs) lost from this condition. Correspondingly, the aim of this study was to define if such associations exist. MethodsIncidence and DALY rates of pediatric patients with idiopathic epilepsy were abstracted by country from the Global Burden of Disease database. Data regarding food availability parameters were identified and abstracted from the Food Systems Dashboard database. Associations were tested using univariate and multivariate regression analyses. ResultsThere were sufficient data in a total of 175 countries. Mean incidence rate and DALYs lost across these countries were 62.3 per 100,000 and 189.2 per 100,000 respectively. Across all countries, higher incidence rates of idiopathic pediatric epilepsy were statistically associated with lower supply of nuts and seeds (P = 0.04), and higher prevalence of moderate or severe food insecurity (P = 0.03). Similarly, higher DALYs lost due to idiopathic pediatric epilepsy were statistically associated with lower supply of fish (P = 0.03), higher supply of starchy roots (P = 0.03), and higher prevalence of moderate or severe food insecurity (P < 0.01). When categorizing countries based on income-status, there was a decrease and divergence in significant associations found between high income versus low-middle income countries. ConclusionsThere are many possible novel associations between national food availability and the incidence rate and DALYs lost due to idiopathic pediatric epilepsy across the world, which may be more pronounced and divergent based on income.

Spectra of intracranial diseases in Chinese military pilots (cadets) unqualified for transfer to pilot modified high performance aircraft.

With very high mortality and disability rates, cerebrovascular diseases and intracranial tumors severely threaten the health and fighting strength of flying personnel, requiring great concern and intensive screening in clinic, early warning in an early and accurate manner and early intervention of diseases possibly resulting in inflight incapacitation are key emphases of aeromedical support in clinic. To probe into the spectra of intracranial diseases, flight factors and medical imaging characteristics of military pilots (cadets) in the physical examination for transfer to pilot modified high performance aircraft, thus rendering theoretical references for clinical aeromedical support of pilots. A total of 554 military pilots (cadets) undergoing physical examination for transfer to pilot modified high performance aircraft from December 2020 to April 2024 in a military medical center were enrolled in this study. Then, a retrospective study was carried out on intracranial disease spectra and head magnetic resonance imaging (MRI) data of 36 pilots (cadets) who were unqualified for transfer to pilot modified high performance aircraft. Besides, a descriptive statistical analysis was conducted on the clinical data, age, fighter type and head MRI data of such pilots (cadets). Abnormal head images were found in 36 out of 554 pilots (cadets) participating in the physical examination for transfer to pilot modified high performance aircraft, including arachnoid cyst in 17 (3.1%) military pilots (cadets), suspected very small aneurysm in 11 (2.0%), cavernous hemangioma in 4 (0.7%), vascular malformation in 2 (0.4%), and pituitary tumor in 3 (0.5%, one of which developed cavernous hemangioma simultaneously). Among the 17 pilots (cadets) with arachnoid cyst, 4 were identified as unqualified for transfer to pilot modified high performance aircraft because the marginal brain tissues were compressed by the cyst > 6 cm in length and diameter. The 11 pilots (cadets) with suspected very small aneurysms identified by 3.0T MRI consisted of 6 diagnosed with conus arteriosus by digital subtraction angiography and qualified for transfer to pilot modified high performance aircraft, and 5 identified as very small intracranial aneurysms with diameter < 3 mm and unqualified for transfer to pilot modified high performance aircraft. No symptoms and signs were observed in the 4 military pilots (cadets) with cavernous hemangioma, and the results of MRI revealed bleeding. The 1 of the 4 had the lesion located in pons and developed Rathke cyst in pituitary gland at the same time, and unqualified for transfer to pilot modified high performance aircraft. The 2 of the 4 were unqualified for flying, and 2 transferred to air combat service division. The 2 pilots (cadets) with vascular malformation were identified as unqualified for transfer to pilot modified high performance aircraft. Among the 3 pilots (cadets) with pituitary tumor, one pilot cadet was identified as unqualified for flying since the tumor compressed the optic chiasma, one had cavernous hemangioma in pons in the meantime and transferred to air combat service division, and one was diagnosed with nonfunctional microadenoma and qualified for transfer to pilot modified high performance aircraft. High-resolution head MRI examination is of great significance for screening and detecting cerebrovascular diseases and intracranial tumors in military flying personnel, and attention should be paid to its clinical application to physical examination for transfer to pilot modified high performance aircraft.

Zinc ions facilitate metabolic bioenergetic recovery post spinal cord injury by activating microglial mitophagy through the STAT3-FOXO3a-SOD2 pathway

Spinal cord injury (SCI) is a devastating condition of the central nervous system (CNS) with high global rates of disability and mortality, and no effective cure currently available. Microglia play a critical role in the progression of SCI, and enhancing their metabolic function may facilitate tissue repair and recovery. Mitochondrial dysfunction is a key feature of metabolic impairment, with the regulation of autophagy being essential for maintaining mitochondrial homeostasis and cell survival. The transcription factor Forkhead box O3a (FOXO3a) is integral to cellular metabolism, mitochondrial dysfunction, and oxidative stress responses, yet its role in post-SCI microglial metabolism remains underexplored. In this study, single-cell RNA sequencing reveals the crucial involvement of the FOXO signaling pathway in zinc ion-mediated enhancement of microglial metabolism. Mechanistically, oxidative stress-induced reactive oxygen species (ROS) accumulation exacerbates metabolic dysfunction by promoting excessive mitochondrial fission and impairing mitophagy. Importantly, zinc ions induce the nuclear translocation of FOXO3a, leading to its activation as a transcription factor. This activation enhances mitochondrial autophagy and fusion processes, thereby restoring microglial metabolic capacity. Our findings suggest that the zinc ion regulation of the STAT3-FOXO3a-SOD2 axis is pivotal in modulating mitochondrial gene expression, which governs microglial energy homeostasis and improves the spinal cord microenvironment, potentially enhancing neuronal survival. These insights highlight a promising therapeutic target for SCI.

Intellectual disability and adjudicative competence evaluations: A detailed review of an often-overlooked population.

Intellectual disability and adjudicative competence evaluations: A detailed review of an often-overlooked population.

Overview of evidence-based research on acupuncture for stroke treatment using magnetic resonance imaging technology.

Stroke is a neurological condition characterized by high rates of disability and mortality. Magnetic resonance imaging (MRI) is widely used to examine the mechanisms of acupuncture in stroke treatment. This review provides neuroimaging evidence for the efficacy of acupuncture in treating stroke using MRI. We conducted a comprehensive search of databases, including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Data, Chinese BioMedical Literature Database (CBM), and Chonqing VIP (CQVIP), from inception to April 2024. Relevant neuroimaging studies on acupuncture for stroke were included, and the research findings were presented through charts and textual analyses. A total of 158 studies were included, and the overall methodological quality of the included studies was moderate to high. The results were divided into three categories: basic characteristics, clinical characteristics, and quality assessment of the included literature. We elucidated the neural mechanisms underlying the effects of acupuncture on stroke; however, the evidence remains preliminary. There is a need for large-scale, well-designed, multimodal neuroimaging trials. This review represents the first active use of an evidence map to systematically review and illustrate the current state of neuroimaging research on the acupuncture treatment of stroke, thereby providing a valuable reference for future research.

Changes in leisure activity, all-cause mortality, and functional disability in older Japanese adults: The JAGES cohort study.

Leisure activities provide various health benefits for older adults. However, few studies have examined changes in leisure activities and health. This study aimed to determine the association among changes in leisure activities, subsequent all-cause mortality, and functional disability. Using a longitudinal, prospective cohort design, we analyzed data from the Japan Gerontological Evaluation Study (JAGES) in 2010 and 2013 merged with government data on death and long-term care needs by 2020. Changes in leisure activity were defined as four-category exposure based on a question about leisure activities: those with leisure activities in both 2010 and 2013, those who started leisure activities in 2013, those without leisure activities in both 2010 and 2013 (reference group), and those who stopped leisure activities in 2013. All-cause mortality and functional disability were defined as onset during the 6-year follow-up from the 2013 survey. We applied the inverse probability of censoring and treatment-weighted methods for analyses using Cox proportional hazards models, where missingness was addressed using multiple imputation. The study included 38,125 participants with a mean age of 72.8 ± 5.5 years at baseline, and 46.9% were male. Among those without leisure activities between 2010 and 2013 and those who started leisure activities in 2013, mortality rates by 2020 were 28.6% and 21.1%, and functional disability rates were 24.6% and 18.1%, respectively; and in analyses with the inverse probability of censoring and treatment-weighted methods, the hazard ratio for mortality was 0.82 (95% confidence interval (CI), 0.75-0.90) and 0.89 (95% CI, 0.79-1.01) for functional disability, respectively. Initiation of leisure activities among the older adults was associated with a lower risk of mortality and functional disability over the subsequent 6 years compared to older adults who did not report initiating any leisure activities.

Association of multiple sclerosis with psychiatric disorders and homelessness among veterans in the United States Department of Veterans Affairs healthcare system.

To describe and compare the prevalence of psychosocial and psychiatric disorders among veterans with multiple sclerosis (MS) and a propensity-score-matched group of veterans without MS, and to identify sociodemographic and clinical characteristics associated with comorbid psychosocial and psychiatric problems among veterans with MS. Data were linked and extracted from the Veterans Affairs (VA) Homeless Operations Management and Evaluation System and the Corporate Data Warehouse. The total sample comprised 27,342 veterans in the VA healthcare system between January 1, 2022, and June 30, 2023, who met eligibility criteria for an MS diagnosis (n=13,671) and 1:1 propensity-score-matched sample of veterans who did not have MS (n=13,671). MS diagnosis, substance use disorder (SUD), mental illness, and homelessness were defined using standard ICD-10 codes. Covariates included sex, age, Charlson Comorbidity Index (CCI), and VA service-connected disability rating. A higher prevalence of mental illness among veterans with MS (33%) was found compared with those without MS (31%). Multivariable logistic regression models indicated MS was negatively associated with diagnoses of alcohol use disorder, stimulant use disorders, posttraumatic stress disorder, and schizophrenia/schizoaffective disorder but positively associated with diagnoses of cannabis use disorder and major depressive disorder. MS was not significantly related to homelessness. Disparities in psychosocial and psychiatric disorders among veterans with MS are described. This study provides novel insights regarding rates of homelessness, SUD, and mental illnesses among veterans with MS. Interdisciplinary approaches to identification and management of mental illness, SUD, and homelessness among veterans with MS are critically needed.

3D Technology-Assisted Minimally Invasive Surgery for the treatment of primary brainstem hemorrhage: A prospective cohort study

PurposeThe objective of this study was to assess the therapeutic efficacy of minimally invasive puncture and drainage (MIPD) facilitated by a three-dimensional (3D)-printed guide plate in the management of primary brainstem hemorrhage (PBH). MethodsThis single-center, prospective cohort study enrolled 30 PBH patients who underwent MIPD guided by 3D printing technology and 30 PBH patients who received conservative treatment, serving as the control cohort. The primary endpoint was the proportion of patients achieving modified Rankin Scale (mRS) scores of 1 and 2 at 30 days post-discharge. Secondary endpoints included hematoma volume at admission and post-treatment, incidence of hospital-acquired pneumonia (HAP) and/or rebleeding, in-hospital mortality rate, and length of hospital stay. ResultsThe treatment cohort demonstrated a significantly higher proportion of patients with mRS scores of 1 and 2 at 30 days post-discharge compared to the control cohort. Conversely, the treatment cohort exhibited significantly lower postoperative hematoma volumes, National Institutes of Health Stroke Scale (NIHSS) scores, HAP incidence, in-hospital mortality, and hospital stay duration than the control cohort. However, no significant difference in rebleeding incidence was observed between the two cohorts. ConclusionMIPD guided by 3D printing technology is more effective than conservative treatment in PBH cases without extensive hemorrhage. This approach can alleviate hematoma pressure earlier, mitigate neurological deficits, reduce HAP incidence, shorten hospital stay, and decrease mortality and disability rates associated with PBH.