Risk Of Disability Research Articles

Effect of Q angle on some performance parameters in adolescent female football players

QA (Q angle) is the line between the combined traction of the quadriceps and the patellar tendon and is associated with the biomechanical function of the lower extremity. The reason we're focusing on the Q angle in women in particular is that we think that in studies women show a higher average QA than men and can give a lot of ideas as a simple precursor parameter. This study aimed to study the effect of the Q angle in Adolescent Women's Footballers on lower extremity vertical jumping performance and the excentric power of the hamstring. Method: A digital manual goniometer was used to measure the QA of individuals, and hamstring eccentric muscle strength NORDBORD device was used for measuring vertical jumping strength with a SmartSpeed Contact Mat half-squat vertical jump test (VJ TEST) The resulting data was normally distributed, and a Pearson correlation test and simple regression tests were applied to the analysis. Results: When the results of simple linear regression analysis of Vertical Jump Performance according to the prediction of the Left Q angle variable were examined, it was seen that the Left Q angle was a significant predictor of the athlete's Vertical Jump performance. In addition, it is seen that there is a moderate positive relationship between Vertical Jump and Asymmetry. Discussions: Football is a competitive game with different dynamics (sprint, change of direction, jumping, collision) and has a higher risk of disability than other sports.

Relationship between self-rated health, physical frailty, and incidence of disability among Japanese community-dwelling older adults: A longitudinal prospective cohort study.

Poor self-rated health (SRH) and physical frailty are both significant predictors of disability in older adults, but their joint association on health outcomes remain unclear. This study aimed to examine the relationship between SRH, physical frailty, and incidence of disability among community-dwelling older adults. This longitudinal cohort study included 2838 older adults aged 65years or older (mean age, 73.1±5.9years) living in Takahama, Japan, who participated in the baseline assessment from September 2015 to February 2017. Participants were followed prospectively until June 2021. SRH was assessed on a four-point scale, and frailty was evaluated using the Japanese version of the Cardiovascular Health Study criteria. Participants were categorized into four groups based on SRH (Good or Poor) and frailty status (Robust or Frail). Cox proportional hazard models were used to assess the association between these categories and the incidence of disability over a 5-year follow-up. During the median follow-up of 60months, 349 of the 2838 participants developed a disability. The risk of disability was significantly higher in the Poor/Robust (HR 1.64, 95% CI 1.20-2.25), Good/Frail (HR 2.58, 95% CI 1.91-3.49), and Poor/Frail (HR 2.03, 95% CI 1.37-3.01) groups than in the Good/Robust reference group. Frail older adults who report good health were associated with the risk of disability, suggesting that discrepancies between subjective and objective health assessments may lead to adverse outcomes. Recognizing and addressing these discrepancies is crucial to promote successful aging.

Abstract TMP62: Early Intensive Blood Pressure Lowering within 6 hours of Intracerebral Hemorrhage Onset is Associated with Improved Functional Outcomes in Larger Trials, but Inconclusive Evidence Overall: A Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials

Background: Elevated blood pressure (BP) is common after Intracerebral Hemorrhage (ICH) and is linked with increased morbidity and mortality, partly due to hematoma expansion. We conducted a systematic review and meta-analysis to determine the effect of BP lowering within 6 hours of ICH onset on functional outcome at 90 days, including a subgroup analysis of undifferentiated stroke patients. Methods: We searched PubMed, Embase, Cochrane Central, Google Scholar, and Clinicaltrials.gov for randomized controlled trials (RCTs). Odds ratio (ORs) with 95% CI were pooled across trials using a random-effects model for the outcomes of 1) change in modified Rankin Scale (mRS) score at 90 days; 2) 90-day death; 3) combined death or disability (mRS>2); 4) significant hematoma expansion (>6ml or >33% of baseline) and 4) serious adverse events (SAEs). The above analyses were replicated in the patients with undifferentiated (radiologically unconfirmed) stroke who recieved pre-hospital BP lowering. Trial sequential analysis (TSA) was performed to determine cumulative evidence strength. Results: We included 9 RCTs with 11,773 patients; 5884 (49.9%) of whom received early BP control within 6 hours of ICH onset. Early BP lowering therapy was associated with a favorable change in 90-day mRS scores (OR 0.88; 95% CI 0.78-0.98; Fig.1A), a reduced risk of death (OR 0.86; 95% CI 0.75-0.98; Fig.1B), a lower risk of death or disability (OR 0.85; 95% CI 0.73-0.99; Fig.2A) and reduced risk of significant hematoma expansion (OR 0.74; 95% CI 0.58-0.95; Fig.2B) in larger trials. On pooling the results of smaller RCTs (<100 patients) with those from larger trials, none of the above outcomes were significant. The same was true for prehospital BP management in undifferentiated stroke. No increased risk of SAEs was observed. TSA indicated that the current evidence is inconclusive to reach definitive conclusions for both the 90-day death outcome and the combined death or disability at 90 days in the primary analysis. Conclusion: Early BP lowering within 6 hours ICH of onset had no increased risk of SAE and is associated with improved 90-day mRS scores, reduced mortality, lower combined death or disability rates, and reduced risk of hematoma expansion in larger trials, which becomes non-significant on pooled analysis of larger and smaller trials. TSA indicated the need for additional trials with larger sampling sizes to confirm these findings.

Iron Chelation Prevents Age-Related Skeletal Muscle Sarcopenia in Klotho Gene Mutant Mice, a Genetic Model of Aging.

A decline in skeletal muscle mass and function known as skeletal muscle sarcopenia is an inevitable consequence of aging. Sarcopenia is a major cause of decreased muscle strength, physical frailty and increased muscle fatigability, contributing significantly to an increased risk of physical disability and functional dependence among the elderly. There remains a significant need for a novel therapy that can improve sarcopenia and related problems in aging. Iron accumulation, especially catalytic iron (labile iron) through increased oxidative stress, could be one of the contributing factors to sarcopenia. Our study aimed to examine the effect of an iron chelator on age-related sarcopenia in mice. We investigated the effect of iron chelation (deferiprone, DFP) in sarcopenia, using mice with klotho deficiency (kl/kl), an established mouse model for aging. Four weeks old Klotho -/- male mice were treated with 25 mg/kg body weight of iron chelator deferiprone in drinking water for 8-14 weeks (n = 12/group, treated and untreated). At the end of the study, gastrocnemius, quadriceps and bicep muscles were dissected and used for western blot and immunohistochemistry analysis, histopathology and iron staining. Serum total iron, catalytic iron and cytokine ELISAs were performed with established methods. Treatment with DFP significantly reduced loss of muscle mass in gastrocnemius and quadriceps muscles (p < 0.0001). Total and catalytic iron content of serum and iron in muscles were significantly (both p < 0.0001) lower in the treated animals. The inhibitory factor of myogenesis, the myostatin protein in gastrocnemius muscles (p = 0.019) and serum (p = 0.003) were downregulated after 8 weeks of therapy accompanied by an increased in muscle contractile protein myosin heavy chain (~2.9 folds, p = 0.0004). Treatment decreased inflammation (serum IL6 and TNFα) (p < 0.0001, p = 0.005), respectively, and elevated insulin-like growth factor levels (p = 0.472). This was associated with reduced DNA damage and reduced 8-hydroxy 2 deoxyguanosine in muscle and HO-1 protein (p < 0.001, p = 079), respectively. Significant weight loss (p < 0.001) and decreased water intake (p = 0.012) were observed in untreated mice compared to treatment group. Kaplan-Meier survival curves show the median life span of treated mice was 108 days as compared to 63 days for untreated mice (p = 0.0002). In summary, our research findings indicate that deferiprone reduced age-related sarcopenia in the muscles of Klotho-/- mice. Our finding suggests chelation of excess iron could be an effective therapy to counter sarcopenia. However, additional studies are needed to evaluate and determine the efficacy in humans.

Abstract TP128: Association Between Hospital Volume and Outcomes of Surgical Procedures for Carotid Stenosis in Japan

Background: Postoperative complication rates of carotid endarterectomy (CEA) and carotid artery stenting (CAS) for carotid artery stenosis are recommended to be maintained below a certain threshold. While the association between hospital volume and the complications has been reported, the situation is uncertain in Japan, one of the countries with the highest density of neuro-specialists. This study aimed to investigate the association between hospital volume and outcomes in patients who underwent CEA or CAS in Japan. Methods: We retrospectively analyzed data from the Japanese nationwide inpatient database on CEA and CAS procedures performed between 2018 and 2021. Hospitals were categorized into four quartiles based on surgical volume, ranging from highest (Q1) to lowest (Q4), with approximately equal numbers of procedures in each quartile. The association between hospital volume and moderate to severe disability (modified Rankin scale &gt; 2 at discharge), in-hospital mortality, perioperative stroke, perioperative pneumonia, and length of hospital stay (LHS) was investigated using multivariate logistic regression and other appropriate analyses. Results: The analysis included 26,675 CEA or CAS procedures performed in 681 hospitals. The overall rates of disability, mortality, perioperative stroke, and pneumonia were 7.4%, 0.5%, 6.6%, and 5.0%, respectively. The rates of disability in Q1, Q2, Q3, and Q4 quartiles were 6.0%, 7.5%, 8.5%, and 7.4%, respectively (Table 1). After adjusting for covariates, Q3 and Q4 were associated with a higher risk of disability (Q3: odds ratio [OR] 1.41, 95% confidence interval [CI] 1.22 – 1.64, Q4: OR 1.41, 95% CI 1.00 - 1.37). Furthermore, Q2, Q3, and Q4 quartiles were associated with a higher risk of perioperative stroke (Q2: OR 1.46, 95% CI 1.26 - 1.70, Q3: OR 1.45, 95% CI 1.25 - 1.69, Q4: OR 2.04, 95% CI 1.77 – 2.36) and pneumonia (Q2: OR 2.01, 95% CI 1.68 – 2.39, Q3: OR 1.89, 95% CI 1.59 – 2.26, Q4: OR 1.79, 95% CI 1.50 – 2.14). The mortality rate was comparable among the four quartiles (Table 2). Additionally, Q2, Q3, and Q4 quartiles were associated with longer LHS. Similar results were observed in patients aged 80 and above. Conclusions: Our findings suggest an association between lower hospital volume and poorer patient outcomes following CEA or CAS. This study indicates the importance of considering surgical volume as a factor to improve outcomes of CEA and CAS in Japan.

High dietary acid load increases the risk of disability in women aged 75 years and older: A community-based cohort study.

Metabolic acidosis caused by acidogenic diets increases muscle catabolism. High acidogenic diets can increase muscle loss in older adults; however, their association with functional outcomes remains unclear. To investigate whether high acidogenic diets increase the incidence of disability. Longitudinal study. Community-based. We included 1,704 community-dwelling Japanese individuals aged ≥ 75 years without disabilities at baseline (52.2 % females). Baseline dietary acid load was assessed using potential renal acid load (PRAL) values, which reflect urinary acidity-with higher values indicating more acidogenic diets. The outcome measure was the one-year incidence of disability, defined as needing for long-term care or support based on certification by the Japanese long-term care insurance system. As the effects of PRAL are reportedly sex-specific, separate analyses were conducted for males and females. The participants were categorized into tertiles (T1-T3, with T1 as the reference) based on their PRAL values. Odds ratios (ORs) and 95 % confidence intervals (CIs) for outcome were calculated using multiple logistic regression analysis after adjusting for age, body mass index, living status, smoking status, hypertension, diabetes, dyslipidemia, energy intake, and alcohol intake. The PRAL ranges in groups T1, T2, and T3 were: -64.51 to 0.21, 0.27 to 11.34, and 11.41 to 61.00, respectively, in males, and -61.22 to -3.84, -3.75 to 5.89, and 5.90 to 38.68, respectively, in females. Disabilities occurred in 44 (5.7 %) males and 71 (8.7 %) females. ORs (95 % CIs) for disability in T2 and T3 were 0.79 (0.35-1.76) and 0.81 (0.37-1.79), respectively, in males and 1.10 (0.57-2.13) and 1.96 (1.06-3.61), respectively, in females. A high dietary acid load increased the incidence of disability in older females. Therefore, managing an acidogenic diet may help maintain daily living functions in older females. Future studies should investigate whether sex is an effect modifier.

Assessment of clinical prognosis in autoimmune encephalitis: Girona score

BackgroundThe assessment of clinical prognosis in autoimmune encephalitis: Girona (ACPE-Gi) score is a scale for evaluating the severity in the acute phase of autoimmune encephalitis (AE) and predicting the risk of disability at 3 months, measured by modified Rankin scale (mRS).MethodsPatients were strictly diagnosed with AE according to the current criteria between 1 January 2009 to 31 March 2023 at the University Hospital Dr. Josep Trueta of Girona, Catalonia, Spain. ACPE-Gi score included 14 items, and every item was scored from 0 to 3, depending on their severity with a sum ranging from 0 to 41.ResultsACPE-Gi score measured the severity in the acute phase and grouped the patients into three groups: mild (&amp;lt;8; 32%), moderate (8 to 15; 60%), and severe (&amp;gt;15; 8%). We found that the third group had a higher risk of disability compared with the first group (p = 0.035). We identified that the mean initial score was significantly higher in the group of patients who had higher mRS at 3 months compared to that in the group of patients who had a mild to moderate disability level (mRS ≤ 2) at 3 months (p = 0.023). In addition, autonomic symptoms and mental status impairment demonstrated to be independent risk factors to predict disability (p &amp;lt; 0.05).ConclusionsThe ACPE-Gi score seems to be a reliable scale for comprehensively evaluating the severity of AE in the acute phase and predicting the risk of disability at 3 months. Dysautonomia and altered mental status predict a poorer prognosis in patients with AE.

The PRO-AGE Tool and Its Association With Post Discharge Outcomes in Older Adults Admitted From the Emergency Department.

Existing risk scores assessing geriatric vulnerability in the emergency department (ED) have shown limited predictive power, especially in diverse populations. We investigated the relationship of a quick and easy-to-administer geriatric vulnerability scoring system with functional decline and mortality in older patients admitted to multiple hospitals through the ED in the United States (US) and Brazil (BR). Federated, international, multicenter observational study of hospitalized ED patients aged ≥ 65 from US and BR. The six criteria from the PRO-AGE score (Physical impairment, Recent hospitalization, Older age [≥ 90], Acute mental alteration, Getting thinner, and Exhaustion; 0-8; higher scores = greater vulnerability) were assessed on admission. We used proportional hazards models to investigate the relationships between PRO-AGE score groups and 90-day mortality and functional decline, defined as new dependence in activities of daily living (ADL) and instrumental ADL (IADL), after adjusting for age, sex, race and ethnicity, education, Charlson comorbidity score, and study site. Death was considered a competing event for the functional decline outcome. A total of 1390 patients were included (US = 560; Brazil = 830). The 90-day risk of death was higher for the upper compared with the lower (reference) PRO-AGE group in both cohorts (US: HR = 11.76; 95% confidence interval [CI] = 2.56-54.04; BR: HR = 12.29; 95% CI = 3.54-42.59), whereas the risk of new 90-day ADL disability was higher for upper (HR = 2.08; 95% CI = 1.21-3.56) and middle groups (HR = 2.10; 95% CI = 1.35-3.27) in the US but only the upper group in BR (HR = 1.70; 95% CI = 1.02-2.85). A higher PRO-AGE score was associated with mortality and functional decline in older ED patients admitted to hospitals in the US and BR, demonstrating its generalizability as a geriatric vulnerability risk score.

P0246 Predicting Operative Recurrence in Crohn's Disease Using a Nomogram Incorporating Histopathological Factors

Abstract Background Crohn's disease (CD) poses a substantial risk of disability and often necessitates recurrent surgical interventions. To date, no association between histologic activity and relapse in CD were found. Methods Data were retrieved from a prospective inflammatory bowel disease registry. Two blinded pathologists graded the inflammation and fibrosis of archived specimens from primary ileal or ileocolonic resections based on an established histopathological score. Factors associated with earlier operative recurrence were identified using a multivariate logistic regression model. A nomogram was constructed to predict reoperation, with model performance assessed using receiver-operating characteristic (ROC) curves and decision curve analysis (DCA). Results Among the 133 patients (68.4% male), the median time to reoperation was 31.9 months (IQR, 14.1-65.7 months). Fourteen reoperations were detected, 4 for abscess/fistula/perforation and 10 for stricture/stenosis. Fifty-four patients experienced endoscopic recurrence within a median time of 10.7 months (IQR, 4.53-18.9 months). Factors associated with reoperation included disease behavior (stricturing, OR 12.1, 95% CI 1.8-80.9; penetrating, OR 9.9, 95% CI 1.4-67.9) and the degree of intestinal fibrosis in the resected specimens (OR 12.1, 95%CI 1.2-126.6). A nomogram, incorporating fibrosis scores, smoking status, disease behavior, and perianal lesions, was established. Both ROC curve and DCA analysis indicated that the nomogram provided increased benefits for predicting reoperation. Conclusion The established nomogram, integrating fibrosis grading from resected specimens, serves as a practical tool for predicting reoperation in CD patients. This nomogram enables the identification of high-risk patients, facilitating proactive postoperative interventions to mitigate operative recurrence.

Transfer from long-term care to acute care and risk of new permanent cognitive or physical disability among long-term care residents in Canada: protocol for a retrospective cohort study

IntroductionLong-term care (LTC) residents are frequently transferred to acute care hospitals. Transfer decisions should align with residents’ wishes and goals. Decision to transfer to hospital, when not aligned with the...

Association of trajectories of physical frailty status and incident disability in community-dwelling older adults: A longitudinal study.

Frailty is a mediator between robustness and functional disability. This study examined the association between remission of frailty and incident disability. The present study analyzed longitudinal data from 2601 community-dwelling older adults who were aged ≥65 years (mean age 70.8 ± 4.5 years, 1307 women [50.2%]) using the Cardiovascular Health Study criteria. Next, examining changes in status from wave 1 (2011) to wave 2 (2015), participants were categorized into a frailty group (those who remained or became frail), a remission of frailty group (those who were frail and became robust) and a robust group (those who remained robust). Cox proportional hazard modeling was used to determine the change of frailty status from wave 1 to wave 2, as well as incident disability at wave 2 (median duration 35 months). Of those participants who started in the frailty or prefrailty groups at wave 1, 15.8% had an improved frailty status at the 47-month follow up. After adjusting for covariates at baseline, the Cox proportional hazard regression models showed that the hazard ratio of disability among participants who remained robust was significantly less than for those who were in the frailty group (hazard ratio 0.515; 95% confidence interval 0.333-0.796). Our data confirm that among those whose frailty status improved, the risk of disability was lower than for those who remained frail. Geriatr Gerontol Int 2025; ••: ••-••.

Ethical considerations regarding the treatment of extremely preterm infants at the limit of viability: a comprehensive review.

Advancements in perinatal care have improved survival rates of extremely preterm infants born at 22 to 23weeks of gestation, thus introducing new ethical challenges associated with their treatment. Therefore, we reviewed the epidemiological prognosis, treatment evolution, and ethical considerations associated with the care of preterm infants at the limit of viability. We comprehensively searched PubMed to find relevant English-language articles published between January 2014 and July 2024. Survival rates of infants born at 22 to 23weeks of gestation have improved but remain low. Proactive treatment can result in survival rates exceeding 50% for infants born at 22weeks; however, these infants are at high risk for complications and neurodevelopmental impairment. Advancements in obstetric and neonatal care have contributed to improved outcomes. Ethical challenges include balancing survival with the disability risk, managing patients with uncertain prognoses, and considering parental wishes.Conclusion: The care of preterm infants at the limit of viability presents complex ethical dilemmas. Shared decision-making between healthcare providers and families as well as engaging in societal discourse are crucial to addressing these challenges.

Prognostic Impact of 1-Year Changes in Creatinine- and Cystatin C-Based Estimated Glomerular Filtration Rate After Stroke on 5-Year Outcomes: Insights From the Third China National Stroke Registry.

The impact of long-term renal function change on stroke outcomes remains unclear. This study used the CNSR-III (Third China National Stroke Registry) cohort to determine whether changes in estimated glomerular filtration rate based on creatinine and cystatin C (eGFRCr+CysC) during the first year post stroke were associated with 5-year stroke outcomes. We included 4270 patients with centrally tested serum creatinine and cystatin C at admission and 1 year post admission and evaluated 5-year follow-up data. Patients were stratified into quintiles based on the 1-year changes in eGFR. The primary outcomes included all-cause mortality, stroke disability, and stroke recurrence. In patients with acute ischemic stroke, the mean baseline eGFRCr+CysC was 88.6±22.6 mL/min per 1.73 m2, which decreased by 5.6% to 83.6±20.7 mL/min per 1.73 m2 at 1 year. Compared with patients with relatively stable eGFRCr+CysC (Q3), those with decreased eGFRCr+CysC (Q1) exhibited significantly increased adjusted risk of death (hazard ratio [HR], 1.96 [95% CI, 1.27-3.04], P=0.003) and those with increased eGFRCr+CysC (Q5) exhibited borderline significance (HR, 1.51 [95% CI, 0.94-2.42], P=0.09), after adjusting for confounders, including baseline eGFRCr+CysC and albumin-to-creatinine ratio. Patients with a significant decrease (odds ratio [OR], 1.74 [95% CI, 1.25-2.42], P=0.001) or increase (OR, 1.51 [95% CI, 1.06-2.15], P=0.02) in eGFRCr+CysC also experienced a higher risk of disability. Both the decline and increase in eGFRCr+CysC levels in the first year post stroke were independently associated with all-cause mortality and stroke disability. These findings indicate that monitoring eGFRCr+CysC changes could be important for predicting long-term outcomes and informing poststroke care strategies.

Associations Between Adherence to the Mediterranean Diet and Incident Sarcopenia in Prospective Cohort Studies.

The loss of skeletal muscle mass and strength, known as sarcopenia, is prevalent in older adults and linked to an increased risk of disability, frailty, and early mortality. Muscle health is crucial for the functionality and independence of older adults. As the aging population continuously grows, finding cost-effective strategies for preventing and treating sarcopenia is an important public health priority. While nutrition is recognized as a key factor in the development of sarcopenia, its role in preventing and treating the condition is still under investigation. In recent decades, nutritional research has shifted from a focus on individual nutrients or healthy foods to examining the combination of nutrients and foods in dietary patterns, along with their potential synergistic and antagonistic effects. A balanced diet and regular participation in physical activity are essential for maintaining musculoskeletal health. One of the healthy eating patterns with the greatest evidence of multiple health benefits is the Mediterranean diet, which has also been linked to positive effects on muscle function in observational studies. However, there is a lack of intervention studies. This review explores the updated evidence from longitudinal prospective studies on associations between adherence to the Mediterranean diet and sarcopenia in order to promote preventive and intervention strategies for healthy muscle aging.

Associations between cardiovascular-kidney-metabolic syndrome and disability in activities of daily living: a nationwide longitudinal study among the middle-aged and older adults in China.

Activities in daily living (ADLs) disability triggered by aging population and chronic diseases in the middle-aged and older adults has become a major public health challenge. Cardiovascular-kidney-metabolic (CKM) syndrome, as a combination of several chronic conditions, has not yet been studied to explore its association with ADLs disability. We examined the association between CKM syndrome and ADLs disability among middle-aged and older adults in China and whether it varied by age and socioeconomic status. Participants were from China Health and Retirement Longitudinal Study (CHARLS), which conducted four waves of surveys from 2011 to 2018. CKM stage was calculated through disease and physical examination data from CHARLS database. Meanwhile, the degree of disability was assessed through the ADL scale. Generalized linear mixed model was used to perform multivariate analysis to explore the association between CKM syndrome and the risk of ADLs disability. The proportion of CKM stage 0, 1, 2, and 3 among the 5,898 eligible participants (median age 60 years, 60.27% women) in 2011 were 14.70, 30.23, 41.39, and 13.68%. The risk of ADL disability was increased by 16% (odds ratio [95% confidence interval]; 1.16 [1.00-1.33]) and 33% (1.33 [1.12-1.58]) in CKM stages 2 and 3 compared with stage 0. In addition, there was a greater risk of BADL disability in 75+ age group compared to other age groups, but no significant association with IADL disability. In the subgroup aged 75+, the risk of BADL disability was increased for CKM stage 2/3 (1.48 [1.01-2.18]/1.67 [1.06-2.64]) compared with stage 0. Only in the lowest quartile of socioeconomic status group CKM stage rise was strongly associated with the risk of disability. The risk of ADL disability was greater for CKM stage 2/3 (1.45 [1.15-1.83]/1.48 [1.11-1.98]) compared to CKM stage 0 in the lowest economic status quartile. For middle-aged and older adults in China, CKM syndrome is a key risk factor for ADLs disability. Therefore, effective measures should be taken to manage CKM stage at the lowest possible level, especially in older and economically disadvantaged populations.

Multimodality cardiac imaging in ischemic stroke: insights into the heart-brain interaction.

Annually, approximately 7.6 million individuals experience a new ischemic stroke, and roughly 25% of all ischemic strokes are cardiogenic in origin, carrying a high risk of recurrence, death and disability. To prevent future ischemic strokes, especially in younger individuals, it is crucial to detect and treat direct and indirect cardioembolic sources. Cardiac imaging is a rapidly evolving field, and post-stroke cardiac imaging is no longer limited to echocardiography, but also includes other imaging techniques, such as cardiac magnetic resonance imaging and cardiac computed tomography. Clinicians must be familiar with numerous cardiac and systemic disorders related to stroke and consider the possibilities that imaging diagnostics have to offer. Additional diagnostics tests, such as pre- and transcranial ultrasound with a bubble test, can also increase the diagnostic accuracy for detecting right-left shunt embolisms. Moreover, a patent foramen ovale (PFO) has traditionally been indicated as a minor or uncertain risk factor for ischemic stroke. However, PFO-associated strokes are a distinct category among the cardioembolic sources as in most cases we do not assume that the thrombus has been developed in-situ in the PFO-structure or elsewhere intracardial, but that PFO merely is acting as a mediator for a paradoxical, venous embolism. The article has two parts: Part I, the heart-brain axis, describes multimodality cardiac imaging in the assessment of cardioembolic sources of ischemic stroke, with a special focus on disorders that traditionally have received little attention in the literature. Part II discusses the brain-heart axis, namely when acute cerebrovascular events lead to cardiac dysfunction, for example neurogenic stunned myocardium and Takotsubo syndrome. Advances in cardiovascular imaging have significantly enhanced the detection of cardiac disorders associated with stroke. Clinicians involved in post stroke work-up need to be aware of the capabilities of different imaging modalities for higher individual diagnostic accuracy in order to effectively treat and prevent stroke recurrence.

Deleterious coding variation associated with autism is consistent across populations, as exemplified by admixed Latin American populations.

Branko Aleksic, Mykyta Artomov, Mafalda Barbosa, Elisa Benetti, Catalina Betancur, Monica Biscaldi-Schafer, Anders D. Børglum, Harrison Brand, Alfredo Brusco, Joseph D. Buxbaum, Gabriele Campos, Simona Cardaropoli, Diana Carli, Angel Carracedo, Marcus C. Y. Chan, Andreas G. Chiocchetti, Brian H. Y. Chung, Brett Collins, Ryan L. Collins, Edwin H. Cook, Hilary Coon, Claudia I. S. Costa, Michael L. Cuccaro, David J. Cutler, Mark J. Daly, Silvia De Rubeis, Bernie Devlin, Ryan N. Doan, Enrico Domenici, Shan Dong, Chiara Fallerini, Magdalena Fernandez, Montserrat Fernández-Prieto, Giovanni Battista Ferrero, Eugenio Ferro, Jennifer Foss Feig, Christine M. Freitag, Jack M. Fu, Liliana Galeano, J. Jay Gargus, Sherif Gerges, Elisa Giorgio, Ana Cristina Girardi, Stephen Guter, Emily Hansen-Kiss, Erina Hara, Danielle Halpern, Gail E. Herman, Luis C. Hernandez, Irva Hertz-Picciotto, David M. Hougaard, Christina M. Hultman, Suma Jacob, Miia Kaartinen, Lambertus Klei, Alexander Kolevzon, Itaru Kushima, Maria C. Lattig, So Lun Lee, Terho Lehtimäki, Lindsay Liang, Carla Lintas, Alicia Ljungdahl, Andrea del Pilar Lopez, Caterina Lo Rizzo, Yunin Ludena, Patricia Maciel, Behrang Mahjani, Nell Maltman, Marianna Manara, Dara S. Manoach, Dalia Marquez, Gal Meiri, Idan Menashe, Judith Miller, Nancy Minshew, Matthew Mosconi, Marina Natividad Avila, Rachel Nguyen, Norio Ozaki, Aarno Palotie, Mara Parellada, Maria Rita Passos-Bueno, Lisa Pavinato, Katherine P. Peña, Minshi Peng, Margaret Pericak-Vance, Antonio M. Persico, Isaac N. Pessah, Thariana Pichardo, Kaija Puura, Abraham Reichenberg, Alessandra Renieri, Kathryn Roeder, Catherine Sancimino, Stephan J. Sanders, Sven Sandin, F. Kyle Satterstrom, Stephen W. Scherer, Sabine Schlitt, Rebecca J. Schmidt, Lauren Schmitt, Katja Schneider-Momm, Paige M. Siper, Laura Sloofman, Moyra Smith, Renee Soufer, Christine R. Stevens, Pål Suren, James S. Sutcliffe, John A. Sweeney, Michael E. Talkowski, Flora Tassone, Karoline Teufel, Elisabetta Trabetti, Slavica Trajkova, Maria del Pilar Trelles, Brie Wamsley, Jaqueline Y. T. Wang, Lauren A. Weiss, Mullin H. C. Yu, Ryan Yuen, Jessica Zweifach.

The association between screened psychological risk for disability and appropriateness of orthopedic surgery in patients with musculoskeletal disorders - data from a Swedish RCT in primary care 2009-2011.

To understand, diagnose and treat patients with musculoskeletal disorders, psychological risk factors should be assessed, and the association between psychological risk for disability and appropriateness of orthopedic surgery should be investigated. To investigate the association between screened psychological risk for disability and appropriateness of orthopedic surgery, and to examine a physiotherapist's ability to assess risk for disability in patients referred for orthopedic consultation. Patients (n = 192) were assessed by a physiotherapist or an orthopedic surgeon to determine the need for surgery. The Pain Belief Screening Instrument (PBSI) was used to screen for psychological risk. The physiotherapist assessed psychological risk for disability based on yellow flags. Association between PBSI risk profile and appropriateness of orthopedic surgery was analyzed using logistic regression. Sensitivity and specificity of the physiotherapist's assessment of risk was calculated using a binary classification model. Orthopedic surgery was 2.28 times more likely to be considered an appropriate intervention for patients with a high PBSI risk profile (95% CI 1.09;4.78). The physiotherapist's risk assessment correctly identified 88% of those at low risk (specificity) and 32% of those at high risk for disability (sensitivity). The findings suggest that orthopedic surgery is likely to be considered appropriate for patients with a high PBSI risk profile. The high specificity of the physiotherapist's assessment implies good awareness of psychological factors. The low sensitivity suggests a need for using a screening tool such as the PBSI, to guide management decisions.Trial registration: Clinical Trials NCT02265172, retrospectively registered June 10, 2014.

The Role of IL-6 and TNF-Alpha Biomarkers in Predicting Disability Outcomes in Acute Ischemic Stroke Patients.

Inflammatory biomarkers, including Interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-alpha), play a significant role in influencing stroke outcomes, particularly in the progression of post-stroke disability. While numerous studies have suggested a correlation between elevated levels of these cytokines and poor functional recovery, further investigation is needed to understand their prognostic value in acute ischemic stroke. We conducted a prospective study on 56 patients diagnosed with acute ischemic stroke, evaluating IL-6 and TNF-alpha levels on days 1 and 7 post symptom onset. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and functional outcomes were measured with the modified Rankin Scale (mRS). Statistical analyses were performed to evaluate the association between biomarker levels and stroke severity and recovery. Our study demonstrated that elevated levels of IL-6 and TNF-alpha on both days 1 and 7 were significantly correlated with greater stroke severity and poorer functional outcomes, as indicated by higher NIHSS and mRS scores. These findings are consistent with broader research indicating strong associations between inflammatory cytokines and post-stroke disability, further reinforcing their relevance as prognostic indicators. IL-6 and TNF-alpha are promising biomarkers for predicting stroke severity and functional recovery in acute ischemic stroke. Monitoring these cytokines in the early stages of stroke could aid in identifying patients at higher risk for long-term disability, potentially guiding personalized therapeutic strategies. Further research into anti-inflammatory therapies targeting these cytokines may improve stroke rehabilitation and outcomes.

Progress in lung cancer study coupled with cognitive frailty in elderly individuals.

Cognitive frailty is increasingly prevalent among elderly patients, heightening the risks of dementia, disability, and mortality. This demographic also faces a rising incidence of lung cancer, and cognitive frailty complicates rehabilitation efforts. Research on cognitive frailty in elderly lung cancer patients is still emerging. This review examines the definition and assessment of cognitive frailty, its the current prevalence in this population, and nursing management strategies. While tools for assessing cognitive frailty are not standardized, the incidence remains high, leading to adverse health outcomes. Comprehensive interventions for elderly lung cancer patients with cognitive frailty are insufficient, highlighting the need for more effective strategies to mitigate this issue. The goal is to enhance both research and clinical practices in identifying and diagnosing cognitive frailty in this vulnerable population.