Elderly Subjects Research Articles

Correlation of deglutitive striated esophagus motor function and pharyngeal phase swallowing biomechanical events.

The functional relationship of striated esophagus (St.Eso) motor function with pharyngeal deglutitive biomechanical events has not been systematically studied. The aim of this study was to determine the spatio-temporal characteristics of St.Eso function and its correlation with pharyngeal biomechanics and bolus transport. We studied 50 healthy volunteer subjects (age range: 21-82 years, 31 female) by digital videofluoroscopy. All subjects were studied in a seated, upright position. Thirteen of these 50 volunteers also underwent high-resolution manometry (HRM) concurrent with fluoroscopy. We used laryngeal excursion as a surrogate for St.Eso excursion. Median duration of St.Eso excursion was 2.35 [1.93,2.85, 5th and 95th percentile] seconds. Mean maximum extent of St.Eso excursion was 2.84 ± 0.72 cm. We identified four distinct periods in deglutitive St.Eso motor function: P1. Anterosuperior ascent without bolus or peristaltic activity, P2. Non-peristaltic bolus receiving at the apogee of St.Eso excursion concurrent with UES opening and pharyngeal peristalsis P3. Peristaltic bolus transport as St.Eso descends and P4. Continued peristalsis in resting position. 1. St.Eso motor function spans both pharyngeal and esophageal phases of swallowing for receiving and transporting the bolus, 2. Pressure signatures in HRM recordings currently attributed to St.Eso deglutitive motor activity does not represent the entirety of St.Eso peristalsis, only the part that occurs in its resting position. St.Eso peristalsis that occurs during its descent is recorded by pressure sensors initially in the pharynx. This finding needs to be considered when interpreting HRM recordings of the pharynx and proximal esophagus.

Accelerated 3D whole-heart non-contrast-enhanced mDIXON coronary MR angiography using deep learning-constrained compressed sensing reconstruction

ObjectivesTo investigate the feasibility of a deep learning-constrained compressed sensing (DL-CS) method in non-contrast-enhanced modified DIXON (mDIXON) coronary magnetic resonance angiography (MRA) and compare its diagnostic accuracy using coronary CT angiography (CCTA) as a reference standard.MethodsNinety-nine participants were prospectively recruited for this study. Thirty healthy subjects (age range: 20–65 years; 50% female) underwent three non-contrast mDIXON-based coronary MRA sequences including DL-CS, CS, and conventional sequences. The three groups were compared based on the scan time, subjective image quality score, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). The remaining 69 patients suspected of coronary artery disease (CAD) (age range: 39–83 years; 51% female) underwent the DL-CS coronary MRA and its diagnostic performance was compared with that of CCTA.ResultsThe scan time for the DL-CS and CS sequences was notably shorter than that of the conventional sequence (9.6 ± 3.1 min vs 10.0 ± 3.4 min vs 13.0 ± 4.9 min; p < 0.001). The DL-CS sequence obtained the highest image quality score, mean SNR, and CNR compared to CS and conventional methods (all p < 0.001). Compared to CCTA, the accuracy, sensitivity, and specificity of DL-CS mDIXON coronary MRA per patient were 84.1%, 92.0%, and 79.5%; those per vessel were 90.3%, 82.6%, and 92.5%; and those per segment were 98.0%, 85.1%, and 98.0%, respectively.ConclusionThe DL-CS mDIXON coronary MRA provided superior image quality and short scan time for visualizing coronary arteries in healthy individuals and demonstrated high diagnostic value compared to CCTA in CAD patients.Critical relevance statementDL-CS resulted in improved image quality with an acceptable scan time, and demonstrated excellent diagnostic performance compared to CCTA, which could be an alternative to enhance the workflow of coronary MRA.Key PointsCurrent coronary MRA techniques are limited by scan time and the need for noise reduction.DL-CS reduced the scan time in coronary MR angiography.Deep learning achieved the highest image quality among the three methods.Deep learning-based coronary MR angiography demonstrated high performance compared to CT angiography.Graphical

Influence of bilateral transcranial direct-current stimulation on muscle strength and respiratory endurance: Randomized, placebo-controlled, double-blind trial protocol

Transcranial direct current stimulation (tDCS) has become established as an effective therapeutic approach, employed to modulate cortical excitability in various conditions. Nonetheless, few studies have assessed the use of tDCS in improving respiratory performance both in healthy and in subjects with respiratory disfunction. This randomized double-blind placebo-controlled trial evaluated the outcomes of lung function, strength of inspiratory muscles, general strength after intervention with bilateral tDCS both in young and elderly female subjects. Eighty subjects were randomized into four groups divided by age (40 young and 40 elderly) and intervention vs. placebo. After a basal (day 1) evaluation all subjects performed two evaluation/intervention rounds with 48 to 72 h interval. Lung function evaluated with spirometry evaluation with Forced vital capacity (FVC), Forced Expiratory Volume in 1 S (FEV1), FEV1/FVC Ratio, Maximal Voluntary Ventilation (MVV); Dynamic Inspiratory muscle strength evaluated with Powerbreathe and general strength with dynamometer. This study intends to understand the behavior of respiratory muscle strength and endurance after intervention with bilateral cathodal tDCS over the primary motor cortex in healthy young and elderly subjects, as a bridge for larger studies both in healthy and rehabilitation setting.

Mastication Muscle Function in Mandibular Fracture Patients After Open Reduction Internal Fixation (ORIF) (Improved Masticatory Muscle Function in Mandibular Fracture Patients Post Open Reduction Internal Fixation (ORIF) Procedure: A Systematic Review)

The maxillofacial zone is a common site of traumatic injury, which has a direct impact on the aesthetics and function of the patient's face. The mandible is the main structural skeletal bone associated with the face, and the maxillofacial area is a common site of injury. Mandibular fractures have a significant impact on masticatory function. The main cause could also be the patient's ability to chew vigorously until the strength is below normal. This is related to dental comfort and mental attitude. Treatment consisting of surgery along the length of the mandibular fracture, focuses on restoring the structural shape of the mandible, with the hope of restoring normal form and function. Writing purpose systematic review (SR ) for studied further regarding the improvement of masticatory muscle function in mandibular fracture patients after open reduction internal fixation (ORIF). SR writing is done with search and analyze journal from PMC, Pubmed and Science Direct portals with criteria inclusion and exclusion that have been determined. Nine articles journal Which identified four (4) prospective articles, one (1) retrospective, one (1) cross sectional, one (1) systematic review, one (1) case report, and one (1) case control. Of the ten journal articles that have been reviewed, there are articles, all of which measure masticatory muscle function as an indicator of the success of open reduction procedures. fixation (ORIF). It's just that there are various research specifications that vary, both in terms of the age of the research subjects, part of the injury, method, type of action, data analysis and other indicators that need to be considered in each study. There is an increase in masticatory muscle function in mandibular fracture patients after open reduction internal fixation (ORIF).

A Study on Serum Hepatic Enzymes in Smokers and Nonsmoker’s Adult Male

Background: Cigarette smoking is one of the greatest indirect causes of global death and disease. Cigarette smoke consists of many chemicals, including cytotoxic, carcinogenic and free radicals, therefore it affects many organs including liver either directly or indirectly. Objective: The aim of this study was to find out level of serum hepatic enzymes in smokers and non-smokers adult male. Method: This cross-sectional study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka, Bangladesh, from January 2019 to December 2019. Total study subjects were one hundred and twenty with age ranging from 20 to 50 years of male gender, selected from attendance of admitted patients and third &amp; forth class employees of Dhaka Medical College Hospital, Dhaka. Study subjects were grouped smokers as Group A and age and gender matched, nonsmokers as Group B. Group A smokers again divided into three groups. Group A1- heavy smokers (who consume 20 cigarette sticks or more per day) consist of thirty study subjects, Group A2- moderate smokers (who consume 11-19 cigarette sticks per day) consist of thirty study subjects and Group A3- light smokers (who consume 1-10 cigarette sticks per day) consist of thirty study subjects. Serum Alanine Transaminase (ALT), Aspartate transaminase (AST) and Alkaline phosphatase (ALP) level of all study subjects were estimated and recorded. Results: Mean age of the study subjects in group A1, A2, A3 &amp; B were 33.88 years, 34.60 years, 34.60 years and 29.80 years. There was a significant increase in serum ALT, AST and ALP level in heavy, moderate and light smokers when compared to nonsmokers, but the increase was more significant in heavy smokers when compared to moderate smokers, also moderate smokers when compared to light smokers. Conclusion: This study revealed that significantly higher level of serum hepatic enzymes with smokers when compared to that of non smokers. This significantly higher level was also seen in heavy smokers in comparison to moderate smokers, moderate smokers in comparison to light smokers.

Fingerprints of brain disease: connectome identifiability in Alzheimer’s disease

Functional connectivity patterns in the human brain, like the friction ridges of a fingerprint, can uniquely identify individuals. Does this “brain fingerprint” remain distinct even during Alzheimer’s disease (AD)? Using fMRI data from healthy and pathologically ageing subjects, we find that individual functional connectivity profiles remain unique and highly heterogeneous during mild cognitive impairment and AD. However, the patterns that make individuals identifiable change with disease progression, revealing a reconfiguration of the brain fingerprint. Notably, connectivity shifts towards functional system connections in AD and lower-order cognitive functions in early disease stages. These findings emphasize the importance of focusing on individual variability rather than group differences in AD studies. Individual functional connectomes could be instrumental in creating personalized models of AD progression, predicting disease course, and optimizing treatments, paving the way for personalized medicine in AD management.

Retrospective Outcome Analysis of Geriatric Traumatic Brain Injury Treated at a Tertiary Care Center in India

Abstract Background Trauma is a major cause of morbidity and mortality in elderly patients and its management is challenging. Outcome assessment in these patients is difficult because of preexisting chronic medical conditions as it may be impossible to isolate the effect of traumatic brain injury. This study aimed to examine the clinical outcomes and epidemiological and clinicoradiological characteristics of geriatric traumatic brain injury patients at a tertiary care center. Methods The clinical records of patients aged ≥60 years with head injuries treated at King George's Medical University between 2016 and 2020 were included in the study. Patients were followed up in the outpatient department or through telephone consultation. The follow-up period was updated using the Glasgow outcome score (GOS) of patients for current neurological status and relevant radiological investigations. Results The mean age of subjects was 66.16 ± 6.55 years. Road traffic accidents were the most frequent cause of brain injuries (448 [68.5%]). In total, 41% of the study patients had severe head injuries (Glasgow coma scale, GCS &lt; 9) at admission. The in-hospital mortality was 25.2%. In total, 60.7% of discharged patients showed favorable outcomes (GOS: 4 or 5). GCS at admission, best motor response, and associated comorbidity (diabetes mellitus) significantly predicted the outcome at 6 months. The majority of the patients (82.6 %) were 60 to 70 years of age. Conclusion Road traffic accidents are the most frequent cause of brain injuries in geriatrics. Most of them were managed medically, and majority were discharged (74.8%). Out of those discharged, 39.3% had unfavorable outcomes.

Meningiomas in Elderly Subjects: Retrospective Studies of 8 Cases and a Literature Review

Aim. Intracranial meningiomas in adults are mainly benign tumors that develop from the meninges. They are common, accounting for about 18 to 20% of primary intracranial tumors, and they are slow-growing, with a predominance in women. They can occur at any age but are most common after the age of 56. Symptoms vary depending on the location of the tumor, its size, and the anatomical structures it comes into contact with. Surgery is the main treatment modality for meningiomas. The objective of this study is to evaluate the cases of meningiomas in our series and to compare their different aspects, such as epidemiological, clinical, radiological, therapeutic, histological, evolutionary, and prognostic characteristics, with those reported in other series of the literature. We seek to highlight the similarities and differences between our series and previous studies, considering recent advances in this field. Materials and measures. In our series, the retrospective study of 8 cases of intracranial meningioma in elderly subjects diagnosed and operated on at the Neurosurgery Department of a hospital over a period of 4 years. Brain CT and MRI were the primary preoperative diagnostic means. The use of these imaging techniques was essential to establish the diagnosis and plan the surgical procedure. The histopathological study was performed to confirm the post-operative diagnosis and determine the histological type, as well as the grade of the meningiomas, referring to the WHO classification to plan an appropriate follow-up of the management. Results. Meningiomas accounted for 2.33% of intracranial meningiomas in elderly subjects, and 22.22% were in subjects under 65 years of age out of 342 tumors operated on in the Department during the same period. The female predominance was clear, at 62%, compared to 38% for men. The average age of our patients was 69.9 years, with extremes of 65 and 74 years. The main clinical symptoms observed in our patients were headache, motor deficit (hemiparesis, hemiplegia), sensory deficit, convulsions, and cranial pair involvement (optic nerve and facial nerve).On CT, the tumor mass was spontaneously hyperdense in 100% of cases. After the injection of iodine product, there was a homogeneous intense contrast intake in all cases. Only 2 patients in our series performed CT scans, of which we found perilesional edema and mass effect in 100% of cases. No calcifications or bone abnormalities were detected. MRI was performed on all our patients, allowing us to better specify the topographical diagnosis of meningiomas. Overall, surgical excision was complete (Simpson’s grade I and grade II) in 62.5% of cases. The most common histological types were meningotheliomatous meningioma (4 cases), transitional meningioma (1 case), mucoid fibrous meningioma (1 case), and atypical meningioma (2 cases). The post-operative course was favorable in most patients, and the post-operative complications consisted mainly of wound infection (1 case), CSF leakage (1 case), and hemorrhage (1 case).

Hypothyroidism in Metabolic Syndrome.

Metabolic syndrome (MetS) and hypothyroidism are well-established forerunners of atherogenic cardiovascular disease (CVD). It is possible that patients suffering from both these disease entities may have a compounded risk. This study aimed at determining the prevalence of hypothyroidism in MetS. This cross-sectional study was conducted from September 2017 to August 2018 in the department of medicine at a tertiary care hospital in Northern India. Ethical approval was obtained from the institutional ethical committee. The study subjects consisted of 157 patients with MetS, the diagnosis of which was based on the International Diabetes Federation criteria. After a detailed history and physical examination, relevant investigations including complete thyroid profile were done. The data were analyzed using appropriate statistical tests (P < 0.05). In our study, the age of subjects ranged between 14 and 92 years, with a mean ± standard deviation of 48.1 ± 17.01 years. There were more females than males with a male-to-female ratio of 1:1.3. The prevalence of hypothyroidism was 46.5%. Hypothyroidism was more common in females (58.9%) as compared to males (41.1%). Patients with hypothyroidism had significantly higher body weight and body mass index (BMI) in comparison to euthyroid patients. The rest of the anthropometric parameters were comparable. Waist circumference and BMI of overt hypothyroid patients were found to be higher as compared to subclinical hypothyroid patients. Total cholesterol and triglyceride were significantly higher (P = 0.001 and P < 0.001, respectively), while high-density lipoprotein levels were significantly lower in patients with hypothyroidism than the euthyroid group (P < 0.001). Hypothyroidism, especially subclinical hypothyroidism, is a common endocrine disorder in patients with MetS. As MetS and hypothyroidism are independent risk factors for CVD, hence there is a need for screening for hypothyroidism and the treatment of the same can be beneficial in reducing the cardiovascular morbidity and mortality in patients with MetS.

Perceived Usefulness of Robotic Technology for Patient Fall Prevention.

Technology has the potential to prevent patient falls in healthcare settings and to reduce work-related injuries among healthcare providers. However, the usefulness and acceptability of each technology requires careful evaluation. Framed by the Technology Acceptance Model (TAM) and using the Adaptive Robotic Nursing Assistant (ARNA) to assist with patient ambulation, the present study examined the perceived usefulness of robots in patients' fall prevention with implications for preventing associated work-related injuries among healthcare providers. Employing an experimental design, subjects were undergraduate nursing students (N = 38) and one external subject (not a nursing student) who played the role of the patient. Procedures included subjects ambulating a simulated patient in three ways: (a) following the practice of a nurse assisting a patient to walk with the patient wearing a gait belt; (b) an ARNA-assisted process with the gait belt attached to ARNA; (c) an ARNA-assisted process with a subject walking a patient wearing a harness that is attached to ARNA. Block randomization was used with the following experimental scenarios: Gait Belt (human with a gait belt), "ARNA + Gait Belt" (a robot with a gait belt), and "ARNA + Harness" (a robot with a harness). Descriptive statistics and a multiple regression model were used to analyze the data and compare the outcome described as the Perceived Usefulness (PU) of a robot for patient walking versus a human "nurse assistant" without a robot. The independent variables included the experimental conditions of "Gait Belt," "ARNA + Gait Belt," and "ARNA + Harness," the subject's age, race, and previous videogame playing experience. Results indicated that PU was significantly higher in the Gait Belt + ARNA and Harness + ARNA conditions than in the Gait Belt condition (p-value <.01 for both variables). In examining potential influencing factors, the effects of race (White, African American, and Asian), age, and previous video-playing experience were not statistically significant (p-value >.05). Results demonstrated that using robot technology to assist in walking patients was perceived by subjects as more useful in preventing falls than the gait belt. Patient fall prevention also has implications for preventing associated work-related injuries among healthcare providers. Understanding the effects of a subject's perceptions can guide further development of assistive robots in patient care. Robotic engineers and interdisciplinary teams can design robots to accommodate worker characteristics and individual differences to improve worker safety and reduce work injuries.

Respiratory safety of lemborexant in adult and elderly subjects with moderate-to-severe chronic obstructive pulmonary disease.

Because some hypnotics worsen respiratory conditions, it was important to determine the respiratory safety of lemborexant, a competitive dual orexin-receptor antagonist approved to treat adults with insomnia, in subjects with moderate-to-severe chronic obstructive pulmonary disease. E2006-A001-113 (Study 113; NCT04647383) was a multicentre, multiple-dose, randomised, double-blind, placebo-controlled, two-period crossover study in adult subjects with moderate or severe chronic obstructive pulmonary disease (per spirometry-based Global Initiative for Chronic Obstructive Lung Disease [GOLD] criteria). Subjects (N = 30) were randomised to two treatment sequences comprising 8-night treatment periods (washout ≥ 14 days) with lemborexant 10 mg or placebo. Peripheral oxygen saturation (SpO2; primary endpoint), apnea-hypopnea index, objective sleep parameters and sleep architecture measures were assessed after single (Day 1) and multiple (Day 8) doses. There was no significant difference in least-squares mean SpO2 after a single dose of lemborexant (91.1%) versus placebo (91.5%). Although a statistically significant difference in SpO2 was observed after multiple doses (least-squares mean: lemborexant, 91.3%; placebo, 90.8%) favouring lemborexant, this was not considered clinically meaningful. Apnea-hypopnea index was not significantly different between treatments after single or multiple doses. Total sleep time and total rapid eye movement sleep were significantly greater on Days 1 and 8 with lemborexant versus placebo. Treatment-emergent adverse events were reported in five (16.7%) subjects when taking lemborexant and four (13.3%) subjects when taking placebo; treatment-emergent adverse events were mostly mild. Lemborexant was well tolerated and did not adversely impact SpO2 or apnea-hypopnea index after single and multiple doses relative to placebo in subjects with moderate-to-severe chronic obstructive pulmonary disease.

Prognosis of early-stage HFpEF in the community-dwelling elderly: The Northern Shanghai Study.

Heart failure with preserved ejection fraction (HFpEF) is a growing concern among the elderly population, significantly impacting morbidity and mortality rates. This study aimed to screen and investigate the characteristics and prognosis of early-stage HFpEF in the elderly. A total of 1789 community-dwelling individuals aged over 65 from northern Shanghai were enrolled. According to American Heart Association (AHA) guidelines, participants were classified into four groups: HFpEF stage 0, HFpEF stage A, HFpEF stage B and HFpEF stage C. Major endpoints included major adverse cardiovascular events (MACEs), all-cause death and cardiovascular death. After a mean follow-up period of 7.10±1.27years, 1623 elderly subjects were included [HFpEF stage 0 (10.3%), HFpEF stage A (16.3%), HFpEF stage B (60.6%) and HFpEF stage C (12.8%)]. Patients with HFpEF stage A, HFpEF stage B and HFpEF stage C exhibited more MACEs than those in HFpEF stage 0 (P<0.01). Patients with HFpEF stage C had a significantly higher cardiovascular (P<0.001) and all-cause death ratio (P<0.01). With HFpEF stage 0 as a reference, the increases in MACEs were significantly associated with HFpEF stage A [hazard ratio (HR): 2.97, 95% confidence interval (CI) (1.13, 7.82), P<0.05], HFpEF stage B [HR: 2.69, 95% CI (1.09, 6.64), P<0.05] and HFpEF stage C [HR: 4.86, 95% CI (1.88, 12.59), P<0.01] in the Cox regression analysis. Our finding remains unaltered in the sensitivity analysis, with no interaction for effectiveness. Compared with those with HFpEF stage 0, patients with HFpEF, whether in stage B or C, exhibit significantly higher cardiovascular and all-cause mortality in the elderly. This study underscores the importance of early-stage HFpEF screening, particularly in older, asymptomatic stage B individuals.

Incidence of allergic contact dermatitis in Finland 1998-2021: A nationwide registry-based study.

Allergic contact dermatitis (ACD) may be chronic and can cause distress, disability, and absence from work. Nationwide epidemiological studies of ACD are sparse. To use national registry data to study the incidence and aetiology of ACD in the working age population of Finland. Patient records from the years 1998-2021 were obtained from the Finnish Care Register for Health Care. Study subjects aged 18-65 years were selected on the basis of a diagnosis of ACD. Total number of study subjects was 26 701. The incidence of ACD increased until 2016 after which it started to decrease. The increase was more marked in females and ACD was particularly common in women reporting reactions to cosmetics and other chemical products and in people of both sexes reacting to adhesives. The incidence 'ACD of unspecific cause' has decreased since 2016. The most commonly reported allergens were metals, followed by cosmetics. One fourth of subjects had ≥2 ACD diagnoses. The incidence of ACD in working age subjects rose from 1998 to 2016, especially in females. However, the incidence has been decreasing since 2016. Our findings highlight the ongoing and even increasing burden of ACD among the working age population.

Clinical Characteristics and Therapeutic Management of Atopic Dermatitis in Elderly Patients Compared with Young Adult Patients: A Prospective Multicentre Study.

Atopic dermatitis (AD) is the most common chronic inflammatory dermatitis in developed countries, and has a major impact on those affected. Little is known about AD in elderly patients. This prospective multicentre observational study described the clinical characteristics and burden of AD in elderly subjects ≥ 65 years, as well as the therapeutic options chosen for this population in routine care, and compared findings with those in young adults with AD < 30 years. Cohort data from adult patients with moderate-to-severe AD enrolled in a French national prospective registry (December 2020 to May 2023) were analysed. Patients ≥ 65 years made up 12.5% of the total adult cohort and presented less head-and-neck and extremity involvement, and were less affected by generalized forms than young adult patients. Elderly patients predominantly had late-onset AD and had similar disease severity to younger adults. Although the overall impact of AD appeared to be lower in elderly patients and treatment was initially less used in this age group, the substantial impact on sleep and psychiatric comorbidities was similar in older and younger adult patients. Better understanding of AD in elderly patients and the establishment of age-specific treatment guidelines may help dermatologists manage the disease in older people.

The effects of ambient temperature on non-accidental mortality in the elderly hypertensive subjects, a cohort-based study

BackgroundThe association between ambient temperature and mortality has yielded inconclusive results with previous studies relying on in-patient data to assess the health effects of temperature. Therefore, we aimed to estimate the effect of ambient temperature on non-accidental mortality among elderly hypertensive patients through a prospective cohort study conducted in northeastern China.MethodsA total of 9634 elderly hypertensive patients from the Kailuan research who participated in the baseline survey and follow-up from January 1, 2006 to December 31, 2017, were included in the study. We employed a Poisson generalized linear regression model to estimate the effects of monthly ambient temperature and temperature variations on non-accidental mortality.ResultsAfter adjusting for meteorological parameters, the monthly mean temperature (RR = 0.989, 95% CI: 0.984–0.993, p < 0.001), minimum temperature (RR = 0.987, 95% CI: 0.983–0.992, p < 0.001) and maximum temperature (RR = 0.989, 95% CI: 0.985–0.994, p < 0.001) exhibited a negative association with an increased risk of non-accidental mortality. The presence of higher monthly temperature variation was significantly associated with an elevated risk of mortality (RR = 1.097, 95% CI:1.051–1.146, p < 0.001). Further stratified analysis revealed that these associations were more pronounced during colder months as well as among male and older individuals.ConclusionsDecreased temperature and greater variations in ambient temperature were observed to be linked with non-accidental mortality among elderly hypertensive patients, particularly notable within aging populations and males. These understanding regarding the effects of ambient temperature on mortality holds clinical significance for appropriate treatment strategies targeting these individuals while also serving as an indicator for heightened risk of death.

Penicillin susceptibility among Staphylococcus aureus skin and soft tissue infections at a children's hospital.

Shortly after its introduction into clinical practice, Staphylococcus aureus isolates gained resistance to penicillin via the acquisition of β-lactamases. A number of centers have recently described an increase in the proportion of invasive methicillin-susceptible S. aureus (MSSA), which are also susceptible to penicillin (PSSA). Little data are available regarding the prevalence or impact of PSSA in skin and soft tissue infections (SSTI). Community-acquired MSSA SSTI isolates were obtained through a surveillance study at Texas Children's Hospital from January 2017 to December 2021. A total of 200 random isolates underwent PCR for blaZ β-lactamase; blaZ-negative isolates then underwent penicillin susceptibility testing using macrobroth dilution. Isolates which were blaZ negative and had a penicillin MIC ≤0.125 µg/mL were regarded as PSSA with the remainder regarded as penicillin-resistant MSSA (PR-MSSA). All PSSA underwent multilocus sequence typing. Medical records were reviewed. The median age of subjects was 4.2 years (IQR: 1.6-10.5). PSSA accounted for 9% of isolates during the study period. PSSA and PR-MSSA cases were similar with respect to age, demographics, and rates of prior antibiotic exposure. PSSA isolates less often had vancomycin MIC ≥1.5 µg/mL. Furthermore, 39% of PSSA were variants of sequence type 1. In multivariable analyses, penicillin susceptibility was independently associated with both hospital admission and surgical intervention. PSSA account for a small but significant proportion of MSSA SSTI in children. Clinically distinguishing patients with PSSA and PR-MSSA SSTI is challenging. However, PSSA SSTI were independently associated with higher rates of hospital admission as well as the need for surgical intervention suggesting a significant clinical impact.IMPORTANCEThe vast majority of Staphylococcus aureus in the US are penicillin resistant with most clinical labs no longer reporting penicillin susceptibility for this organism. A number of centers, however, have reported increasing penicillin susceptibility among invasive S. aureus infections. Skin and soft tissue infections (SSTI) are far more common than invasive infections, yet the frequency and impact of penicillin-susceptible S. aureus (PSSA) in this population are uncertain. Through active surveillance at a children's hospital, we found that 9% of methicillin-susceptible S. aureus SSTI isolates were PSSA. PSSA were independently associated with hospital admission for the management of SSTI as well as the need for debridement in the operating room. Given that most SSTI are managed in the outpatient setting, these findings suggest a clinical impact of this phenotype and the need for a reassessment of the value in susceptibility testing and potentially even treatment with penicillin.

Subjective Well-Being and Successful Ageing of Older Adults in Eastern Croatia—Slavonia: Exploring Individual and Contextual Predictors

The process of population ageing with socioeconomic and political implications necessitates the creation of sustainable social strategies aimed at societal inclusion, support of subjective well-being and successful ageing of older adults. Therefore, the aim of this cross-sectional study was to explore individual and contextual factors and predictors which impede the possibility of successful ageing. The study was conducted from January to June 2024 through a questionnaire involving 403 elderly participants who live in the Eastern region of Croatia—Slavonia. The Diener Scale of Subjective Well-being and Self-assessment of Successful Ageing Scale were used in this research. A separate and model contribution of predictors (gender, age, subjective age, residence, level of education, marital status, comorbidities, Satisfaction with Life Scale and Prosperity Scale) were examined using bivariate and multivariate regression. Multivariate regression differentiated a statistically significant model, which as a whole explains between 41% and 55% of the variance of the present negative assessment of successful ageing, correctly classifying 80% of cases. The significant predictors included subjective age, place of residence, level of education, comorbidities, Satisfaction with Life Scale, and Prosperity Scale. These findings underscore the importance of both individual and contextual factors in successful ageing within this specific regional context.

Influence of Night Shift Work on Heart Rate Variability in an Age- and Gender-Matched Study Group.

Regular and long-term shift work is associated with a number of chronic diseases. There is some evidence that shift work also has an influence on the autonomous nervous system. Studies that have examined the effect of shift work on heart rate variability (HRV) have not taken into account age and gender. Therefore, the aim of this study was to investigate the influence of night shift based on 24 h long-term analyses carried out on non-night shift days with a matched control group for age and gender. In total, 172 (128 male, 44 female) healthy shift night workers were compared with subjects from a non-night shift worker group at a ratio of 1:1, forming matched pairs based on the subjects' sex and age. HRV parameters were analyzed based on 24 h ECG recording. An analysis of the HRV parameters showed only a small difference but without statistical significance between the two groups with regard to all of the HRV parameters examined (SDNN, RMSSD, NN50, pNN50, VLF, LF, HF, LF/HF, DFA1, and DFA2). An analysis of the subgroup of subjects who had only worked night shifts for a minimum of 10 or 20 years, with the respective pairs matched by age and gender, did not reveal any significant differences between the HRV parameters of employees working night shifts and those not working night shifts. Taking into account qualitative aspects of HRV analysis, this study was thus able to show that working night shifts for many years may not have as big an influence on HRV as had been assumed so far.

A comparative study of vestibular projection connectivity and balance in healthy young adults and elderly subjects

ObjectiveVestibular function is controlled by interactions between various neuropathways that have different effects on balance and are connected to various brain areas. However, few studies have investigated the relation between changes in VN connectivity and aging using neuroimaging. We investigated neural connectivities in the vestibular nucleus (VN) and ventralis intermedius (VIM) nucleus of the thalamus in young and old healthy adults by diffusion tensor imaging.MethodsThis study recruited twenty-three normal healthy adults with no history of a neurological or musculoskeletal disease, that is, eleven old healthy adults (6 males, 5 females; mean age 63.36 ± 4.25 years) and 12 young healthy adults (7 males, 5 females; mean age 28.42 ± 4.40 years). Connectivity was defined as the incidence of connection between the VN, VIM, and target brain regions. Incidence of connection was counted from VN and VIM to each brain region. The subjective visual vertical (SVV) and the Berg balance scale (BBS) were used to assess vestibular function and balance.ResultsThe VN showed high connectivity with brainstem (dentate nucleus, medial longitudinal fasciculus, and VIM), but relatively low connectivity with cerebral cortex (parieto-insular vestibular cortex (PIVC) and primary somatosensory cortex) at a threshold of 30 streamlines. In particular, VN connectivity with PIVC was significantly lower in elderly adults (> 60 years old) than in young adults (20–40 years old) (p < 0.05). VIM showed high to mid connectivity with brainstems and cerebral cortexes at a threshold of 30, but no significant difference was observed between young and old adults (p > 0.05). SVV and BBS showed no significant differences between young and old adults (p > 0.05).ConclusionWe investigated incidences of neural connectivities of VN and VIM in young and old healthy adults. Our results provide basic data that might be clinically useful following injury of vestibular-related areas.

Association of Renal Hyperfiltration with Incidence of New-Onset Diabetes Mellitus: A Nationwide Cohort Study.

Background and Objectives: While the connection between decreased kidney function and diabetes mellitus (DM) is commonly acknowledged, there is insufficient research examining the relationship between higher-than-normal estimated glomerular filtration rate (eGFR) and the incidence risk of new-onset DM. Our research aimed to explore the relationship between an eGFR and the incidence risk of new-onset DM in the Korean general population through a nationwide longitudinal study. Methods: This research employed the cohort records of the National Health Insurance Service in Korea, analyzing records from 2,294,358 individuals between the ages of 20 and 79 who underwent health check-ups between 2010 and 2011. The eGFR levels from the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation were used to assess the renal function. New-onset DM was defined as two or more claims with the International Classification of Diseases-10 classification codes E10 to E14, being prescribed any medication for lowering blood glucose, or having a record of fasting plasma glucose levels of ≥126 mg/dL from a health examination after the index date. Results: The mean age of subjects was 47.34 ± 13.76 years. The 150,813 (6.57%) new-onset DM cases were identified over a median follow-up of 9.63 years. In the multivariable Cox regression analysis, in comparison with the 5th decile, the 10th (≥114.12 mL/min/1.73 m2) (hazard ratio (HR): 0.52, 95% confidence interval (CI) (0.50-0.54), p < 0.001) eGFR decile was significantly associated with a decreased incidence of new-onset DM. Moreover, eGFR >120 mL/min/1.73 m2 was associated with a reduced risk of new-onset DM (HR: 0.40, 95% CI (0.39-0.42), p < 0.001). These results were consistent regardless of the presence of impaired glucose tolerance, age, or obesity. Conclusion: Our study showed higher-than-normal eGFR levels were associated with a lower risk of incidence for new-onset DM regardless of the presence of impaired glucose tolerance, age, or obesity. In general population, higher-than-normal eGFR may be associated with a lower risk of incidence of new-onset DM.