Hasil untuk "Geriatrics"

W. Chow, R. Rosenthal, R. Merkow et al.

Abdoul Razak Sawadogo, Alexandre Lagrange, Anaïs Bosetti et al.

Abstract Background Older adults, with complex needs and an elevated risk of complications, account for a high proportion of emergency visits in France. Mobile geriatric teams (MGTs) and the emergency geriatric medicine unit (EGMU) based in the emergency department (ED) have been developed to improve care. Although the EGMU reduces hospitalizations and readmissions, its cost-effectiveness remains uncertain. Methods This study assessed the incremental cost-effectiveness ratio (ICER) of the EGMU compared to the MGT unit. In all, 338 older patients were included: 102 managed by the MGT unit in January 2014 and 236 in the EGMU in January 2015, which replaced the MGT unit. The primary efficacy endpoint was the rate of readmission to the ED within 30 days (30DRA). We conducted the analysis from the payer’s perspective, incorporated a Monte Carlo simulation, and generated a cost-effectiveness acceptability curve. Result The average cost per patient was estimated to be €5738.16 in the EGMU, compared to €6701.35 in the MGT unit. The mean 30DRA was 0.09 for the EGMU and 0.13 for the MGT unit. The ICER was €24,079 per readmission avoided (RA). The probability that the EGMU would be cost-effective at a willingness-to-pay threshold of €33,622.84 per RA was 63.26%. Conclusion The EGMU appears to be more efficient than the MGT unit, reducing 30DRA and average costs, although further studies are needed to confirm these findings.

Gökhan Eyüpoğlu, Mehmet Tatlı, Ebru Akkoç et al.

Objective: To evaluate the comparative effectiveness of adenosine, diltiazem, and metoprolol in achieving rate control in geriatric patients presenting with supraventricular tachyarrhythmia (SVT) and to identify clinical predictors associated with treatment success. Materials and Methods: This retrospective observational cohort study was conducted in a single tertiary emergency department between January 2021 and December 2024. Patients aged ≥65 years who presented with SVT and were treated with adenosine, diltiazem, or metoprolol were included. Patients were categorized into two groups based on successful rate control (heart rate <100 bpm). Demographics, comorbidities, laboratory parameters, and hemodynamic data were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to determine the independent predictors of treatment success. Receiver operating characteristic (ROC) analysis was conducted to evaluate the prognostic performance of the identified variables. Results: A total of 167 patients were included, of whom 58 (34.7%) achieved rate control. There were no significant differences in age or sex distribution between the groups. Chronic kidney disease was significantly more prevalent in the non-rate control group (17.4% vs. 3.4%, p=0.009). Patients with successful rate control had significantly higher hemoglobin levels (13.6±2.5 vs. 12.7±2.5 g/dL, p=0.01) and glomerular filtration rates (60.7±27.3 vs. 58.7±25.5 mL/min, p=0.015). In the multivariate analysis, only hemoglobin remained an independent predictor of rate control success (odds ratio: 1.154, p=0.037). ROC analysis identified a hemoglobin cut-off of 12.9 g/dL, with a sensitivity of 62.1% and specificity of 63.9% (area under the curve: 0.622). Conclusion: Hemoglobin level is an independent predictor of successful pharmacologic rate control in geriatric patients with SVT. Personalized therapeutic strategies that incorporate hematologic status may optimize treatment outcomes in this vulnerable population. Further prospective studies are required to validate these findings.

Katelyn E. Mooney, Derek B. Archer, Aditi Sathe et al.

Abstract INTRODUCTION We assessed associations between apolipoprotein E Translocase of Outer Mitochondrial Membrane 40 (APOE‐TOMM40)‐‘523 haplotypes and white matter microstructure (WMM) across limbic tracts important for memory and cognition in non‐Hispanic Black and White individuals. METHODS Linear regression models, stratified by APOE and racialized groups, assessed associations between TOMM40‐‘523‐S and limbic tract WMM free‐water (FW) and free‐water‐corrected fractional anisotropy (FAFWcorr). RESULTS Black‐ε4+‐one‐'523‐S carriers had lower FW in the cingulum and inferior longitudinal fasciculus compared to Black‐ε4+‐no‐'523‐S carriers. Additionally, Black‐ε4+‐one‐'523‐S carriers had lower FW in the cingulum, uncinate, and fornix, and higher FAFWcorr in the uncinate compared to Black‐ε4+‐'523‐S/S carriers. White‐ε3/ε3‐‘523‐S/S carriers had lower FAFWcorr in the cingulum and inferior temporal gyrus compared to White‐ε3/ε3‐no‐'523‐S carriers, and lower FAFWcorr in the cingulum compared to White‐ε3/ε3‐one‐‘523‐S carriers. DISCUSSION This supports prior work that ‘523‐S is associated with abnormal aging in White‐ε3/ε3 carriers, but is potentially risk‐mitigating in Black‐ε4+ carriers, while suggesting a differential effect by racialized background of APOE on WMM. Highlights White matter microstructure (WMM) across limbic tracts important for cognition was measured by diffusion MRI. Black apolipoprotein E (APOE) ε4+ carriers with one copy of TOMM40‐‘523‐S had normal aging WMM metrics across several tracts, including the cingulum bundle, uncinate fasciculus, fornix, and inferior longitudinal fasciculus. White APOE ε3/ε3 carriers with two copies of TOMM40‐‘523‐S had abnormal aging WMM metrics in the cingulum bundle and inferior temporal gyrus. APOE associations with aging may differ in racialized groups due to TOMM40‐‘523‐S copy number.

Geethu Poly, Beena Varma, M S Aravind et al.

Context: Evidence shows that knowledge is important in tackling pandemics. By assessing awareness and knowledge about the coronavirus, more profound insights can be gained into existing public reception and practices, thereby helping to identify attributes that influence the adoption of healthy practices and responsive behavior. Assessing knowledge is important in identifying gaps and strengthening ongoing prevention efforts. Aims: The study aimed to investigate the geriatric population's knowledge, attitudes, and practices (KAP) toward coronavirus disease-2019 (COVID-19) during the pandemic spike. Settings and Design: The study was designed as a cross-sectional study; a questionnaire was developed regarding the World Health Organization training material for the detection, prevention, response, and control of COVID-19 and was validated by experts in geriatrics and public health. Materials and Methods: A prevalidated questionnaire consisting of four sections will be used. The first section consists of demographic data such as age and gender. The second, third, and fourth section will include prevalidated questions to gather information about the patient's KAP regarding general awareness of COVID-19 among geriatric patients in a tertiary care center in central Kerala. The inclusion criteria included patients of age 60 years and above, patients who are willing to participate in the study, and patients who are willing to give informed consent. The questionnaire was answered by over 199 participants anonymously from November 01, 2021, to February 08, 2022. Results: In our study, 199 participants were involved the mean knowledge score was 10.3 ± 1.224. The average attitude score regarding COVID-19 among the participants was 1.9 ± 1.1. The majority of the participants (67.8%) had a poor attitude toward COVID-19. There was a significant difference in average attitude scores according to socioeconomic status. According to the present study, the average correct answer score of the ten questions regarding COVID-19 practice was 6.3 ± 1.4. The majority of participants (75.4%) had moderate practice toward COVID-19. The average practice scores were significant difference among the socioeconomic status. Conclusions: The third wave of the pandemic demonstrated good knowledge, positive attitudes, and reasonable practice regarding COVID-19 during the outbreak. The results indicated the need for the health system to attempt to increase the public knowledge of the older people to improve their attitude and practice to deal with the crisis.

Nanda Kleinenberg-Talsma, Fons van der Lucht, Harriët Jager-Wittenaar et al.

Abstract Background Frailty is a common condition in older people, and its prevalence increases with age. With an ageing population, the adverse consequences of frailty cause an increasing appeal to the health care system. The impact of frailty on population level is often assessed using adverse health outcomes, such as mortality and medication use. Use of community nursing services and services offered through the Social Support Act are hardly used in assessing the impact of frailty. However, these services are important types of care use, especially in relation to ageing in place. In this cross-sectional study, we aimed to assess the impact of frailty on use of Social Support Act services, use of community nursing services, medication use, and mortality. Methods We used a frailty index, the FI-HM37, that was based on data from the Dutch Public Health Monitor 2016, for which respondents ≥ 65 years of age were included (n = 233,498). The association between frailty, the use of Social Support Act services, community nursing services and medication use was assessed using the Zero Inflated Poisson (ZIP) regression method. Survival analysis using Cox proportional hazards regression was conducted to estimate the hazard ratios for the association between frailty and mortality. Results The ZIP regression with a final sample size of 181,350 showed that frailty affected care use even after correcting for several covariates mentioned in the literature. For each unit increase in frailty index (FI) score, the relative probability of using zero Social Support services decreased with 7.7 (p < 0.001). The relative chance of zero community nursing services decreased with 4.0 (p < 0.001) for each unit increase in FI score. Furthermore, for each unit increase in FI score, the likelihood of zero medication use decreased with 2.9 (p < 0.001). Finally, for each unit increase in FI score, the mortality risk was 3.8 times higher (CI = 3.4–4.3; p < 0.001). Conclusions We demonstrated that frailty negatively affects the use of Social Support Act services, the use of community nursing services, medication use, and mortality risk. This study is the first to demonstrate the impact of frailty on Social Support Act services and community nursing services in the Netherlands. Findings emphasize the importance of frailty prevention for older people and public health policy.

Yun-Shan Zhang, Kai Zhang, Lang Huang et al.

Abstract Background Respiratory muscle training is a continuous and standardized training of respiratory muscles, but the evidence of the effects on early stroke patients is not clear. This meta-analysis aimed to investigate the effects of respiratory muscle training on respiratory function and functional capacity in patients with early stroke. Methods PubMed, Embase, PEDro, ScienceDirect, AMED, CINAHL, and China National Knowledge Infrastructure databases were searched from inception to December 8, 2023 for articles about studies that 1) stroke patients with age ≥ 18 years old. Early stroke < 3 months at the time of diagnosis, 2) respiratory muscle training, including inspiratory and expiratory muscle training, 3) the following measurements are the outcomes: respiratory muscle strength, respiratory muscle endurance, pulmonary function testing, dyspnea fatigue score, and functional capacity, 4) randomized controlled trials. Studies that met the inclusion criteria were extracted data and appraised the methodological quality and risk of bias using the Physiotherapy Evidence Database scale and the Cochrane Risk of Bias tool by two independent reviewers. RevMan 5.4 with a random effect model was used for data synthesis and analysis. Mean differences (MD) or standard mean differences (SMD), and 95% confidence interval were calculated (95%CI). Results Nine studies met inclusion criteria, recruiting 526 participants (mean age 61.6 years). Respiratory muscle training produced a statistically significant effect on improving maximal inspiratory pressure (MD = 10.93, 95%CI: 8.51–13.36), maximal expiratory pressure (MD = 9.01, 95%CI: 5.34–12.69), forced vital capacity (MD = 0.82, 95%CI: 0.54–1.10), peak expiratory flow (MD = 1.28, 95%CI: 0.94–1.63), forced expiratory volume in 1 s (MD = 1.36, 95%CI: 1.13–1.59), functional capacity (SMD = 0.51, 95%CI: 0.05–0.98) in patients with early stroke. Subgroup analysis showed that inspiratory muscle training combined with expiratory muscle training was beneficial to the recovery of maximal inspiratory pressure (MD = 9.78, 95%CI: 5.96–13.60), maximal expiratory pressure (MD = 11.62, 95%CI: 3.80–19.43), forced vital capacity (MD = 0.87, 95%CI: 0.47–1.27), peak expiratory flow (MD = 1.51, 95%CI: 1.22–1.80), forced expiratory volume in 1 s (MD = 0.76, 95%CI: 0.41–1.11), functional capacity (SMD = 0.61, 95%CI: 0.08–1.13), while inspiratory muscle training could improve maximal inspiratory pressure (MD = 11.60, 95%CI: 8.15–15.05), maximal expiratory pressure (MD = 7.06, 95%CI: 3.50–10.62), forced vital capacity (MD = 0.71, 95%CI: 0.21–1.21), peak expiratory flow (MD = 0.84, 95%CI: 0.37–1.31), forced expiratory volume in 1 s (MD = 0.40, 95%CI: 0.08–0.72). Conclusions This study provides good-quality evidence that respiratory muscle training is effective in improving respiratory muscle strength, pulmonary function, and functional capacity for patients with early stroke. Inspiratory muscle training combined with expiratory muscle training seems to promote functional recovery in patients with early stroke more than inspiratory muscle training alone. Trial registration Prospero registration number: CRD42021291918.

Li Feng Tan, Reshma Aziz Merchant

Background This study aimed to survey knowledge and perceptions of social prescribing (SP) amongst health and community care workers, and is a cross-sectional online survey conducted in November 2023. Methods The survey on basic demographics, awareness, knowledge, and practices of SP was completed by 123 health and community care workers. Results The mean age of respondents was 39.0 years. Nearly two-thirds had heard of SP. A lower proportion of acute hospital doctors (55.6%) and nurses (56.8%) had heard of SP compared with primary and subacute care doctors (75.0%). The majority agreed that SP benefits patients’ mental health and reduces healthcare utilization. Primary care physicians, community nurses, and active ageing centres were the top three professionals selected as most responsible for SP by survey respondents. The most commonly cited barriers to SP were seniors’ reluctance (63.4%), lacking knowledge on how to refer (59.3%), lack of time (44.7%), and cost to seniors (44.7%). Conclusion Overall, health and community care workers demonstrated positive attitudes toward SP and were keen to refer patients for SP. However, additional efforts are needed to improve knowledge about how to refer to and provide training on SP.

Eric Balki, Niall Hayes, Carol Holland

BackgroundDuring the COVID-19 pandemic, government-mandated social distancing prevented the spread of the disease but potentially exacerbated social isolation and loneliness for older people, especially those already vulnerable to isolation. Older adults may have been able to draw from their personal resources such as psychological resilience (PR) and technology use (TU) to combat such effects. Educational attainment (EA) or early-life EA may potentially shape later-life personal resources and their impact on the effects of the pandemic lockdown on outcomes such as loneliness. The developmental adaptation model allows for the supposition that social isolation, TU, and PR may be affected by early EA in older adults. ObjectiveThis study examined the indirect impact of EA on pandemic-linked loneliness in a sample of older adults. The developmental adaptation model was used as the conceptual framework to view EA as a distal influence on loneliness, social isolation, PR, and TU. We hypothesized that EA would predict TU and PR and have a moderating impact on social isolation and loneliness. We also hypothesized that PR and TU would mediate the effect of EA on loneliness. MethodsThis was a cross-sectional observational study, in which data were gathered from 92 older adults aged ≥65 years in the United Kingdom from March 2020 to June 2021, when the country was under various pandemic-linked social mobility restrictions. The data captured demographic information including age, gender, ethnicity, and the highest degree of education achieved. The University of California Los Angeles Loneliness Scale, Connor–Davidson Resilience Scale, Lubben Social Network Index, and Technology Experience Questionnaire were used as standardized measures. Pearson correlation, moderation, and mediation regression analyses were conducted to investigate the hypotheses. ResultsWe found a higher prevalence of loneliness in older adults than in prepandemic norms. EA was correlated with greater TU and PR and moderated the impact of social isolation on loneliness. PR mediated and TU partially mediated the relationship between EA and loneliness. ConclusionsEarly-life EA was confirmed as a distal resource for older adults and played an indirect role in affecting loneliness levels during the pandemic. It has an impact on present-day personal resources, such as PR and TU, which affect loneliness and also moderate the impact of social isolation on loneliness. Policymakers should be aware that older adults with low levels of EA may be more vulnerable to the harmful impacts of loneliness when isolated by choice.

Ivy Yan Zhao, Mu-Hsing Ho, Stefanos Tyrovolas et al.

Abstract Background World Health Organization (WHO) has defined healthy ageing by highlighting five functional ability domains to (meet basic needs, make decisions, be mobile, build and maintain relationships, and contribute to society), which also emphasized the importance of addressing loneliness as priorities within United Nations Decade of Healthy Ageing initiative. However, the level and determinants of healthy ageing and its association with loneliness are rarely examined. This study aimed to construct a healthy ageing index to verify the WHO healthy ageing framework, measure five domains of functional ability of older adults and examine the relationship between functional ability domains and loneliness. Methods A total of 10,746 older adults from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were included. A healthy ageing index ranging from 0 to 17 was constructed using 17 components related to functional ability domains. Univariate and multivariate logistic regression analyses were utilized to determine the association between loneliness and healthy ageing. The STROBE guidelines with the RECORD statement for observational studies using routinely collected health data were observed. Results The factor analysis verified the five functional ability domains for healthy ageing. After adjusting for confounders, being mobile, building and maintaining relationships, and learning, growing and making decisions were significantly associated with lesser loneliness among participants. Conclusions The healthy ageing index of this study can be utilized and further modified with respect to large-scale research with relevant healthy ageing topics. Our findings will support healthcare professionals to provide patient-centered care when identifying their comprehensive abilities and needs.

Sanjo K John, N Padmaja, I V. Ramachandra Rao et al.

Introduction: There is an increased population of elderly globally due to advancement of technology in health care. Elderly individuals are susceptible to various diseases, owing to deficits in nutrition or healthy lifestyle. Serum albumin and C-reactive protein (CRP) are found to be sensitive to nutritional status as well as inflammation. This study is an attempt to analyze the prognostic value of CRP and serum albumin and analyze its usefulness as a prognostic marker in assessing morbidity and mortality in elderly patients. Methodology: One hundred patients above the age of 65 years and were admitted to the emergency care facilities of our tertiary care center were recruited for the study. Serum albumin and CRP estimation was done on the day of admission along with Charlson Comorbidity Index (CCI), and was follow-up till discharge. Statistical analysis was performed to evaluate relationship between the serum values and CCI scores. Results: It was observed that 83.3% (10/12) of deaths occurred in those with low serum albumin levels, and 91.6% (11/12) with high CRP levels. The hazard ratio shows a 6% increased probability of death with one unit increase in CRP, whereas a one unit increase in serum albumin value decrease the probability of death. Conclusion: The present study concludes that low serum albumin and high CRP levels at the time of admission in the elderly population are associated with high CCI scores, longer hospital stay, and increased risk of mortality, demanding their estimation in the elderly in emergency and acute care facilities.

Yong Zhao, Yong Zhao, Dandan Feng et al.

BackgroundPylephlebitis refers to an infective suppurative thrombosis that occurs in the portal vein and its branches. Concurrent pylephlebitis and subarachnoid hemorrhage (SAH) are rare but fatal for patients with sepsis. This scenario drives the clinicians into a dilemma of how to deal with coagulation and bleeding simultaneously.Case summaryAn 86-year-old man was admitted to hospital for chills and fever. After admission, he developed headache and abdominal distension. Neck stiffness, Kernig's and Brudzinski's sign were present. Laboratory tests discovered decreased platelet count, elevated inflammatory parameters, aggravated transaminitis, and acute kidney injury. Escherichia coli (E. coli) were identified in blood culture. Computed tomography (CT) revealed thrombosis in the superior mesenteric vein and portal veins. Lumbar puncture and Brain CT indicated SAH. The patient had eaten cooked oysters prior to illness. It was speculated that the debris from oyster shell might have injured his intestinal mucosa and resulted in bacterial embolus and secondary thrombosis in portal veins. The patient was treated with effective antibiotics, fluid resuscitation, and anticoagulation. The dose titration of low molecular weight heparin (LMWH) under close monitoring attributed to diminution of the thrombosis and absorption of SAH. He recovered and was discharged after 33-day treatment. One-year follow-up indicated that the post-discharge course was uneventful.ConclusionThis report describes a case of an octogenarian with E. coli septicemia who survived from concurrent pylephlebitis and SAH along with multiple organ dysfunction syndrome. For such patients with life-threatening complications, even in the acute stage of SAH, decisive employment of LMWH is essential to resolve thrombosis and confers a favorable prognosis.

Christopher Olusanjo Akosile PhD, Chisom Onyekwuluje BMR, Ukamaka Gloria Mgbeojedo PhD et al.

Objectives: To assess and compare levels of social support (SS), social participation (SP) and life accomplishment (LA) among older adults in some assisted-living facilities (ALFs) and their community-dwelling (CD) peers. Methods: One hundred twenty older adults (54 ALF, 66 CD) from a Nigerian population participated in this cross-sectional survey. The Multidimensional Scale for Perceived Social Support, the Participation Scale and the Life Habit Questionnaires were used to evaluate levels of SS, SP, and LA, respectively. Data was analyzed using descriptive statistics, Mann-Whitney U test and Spearman rank order correlation, at .05 alpha level. Results: Participation restriction (PR) was significantly more prevalent among the ALF group compared to the CD group (χ 2  = 12.74; p  = .01) but the two groups enjoyed comparable level of SS. LA was significantly better for the CD group in the overall score. LA had significant correlation with PR in both the ALFs ( r  = −.44; p  < .05) and CD ( r  = −.62; p  < .05) group. Conclusions: Older adults in ALFs received moderate SS, had LA, and a high PR, while CD older adults received a high SS and LA but had no PR. The findings implicate that social participation and enhancing community support for older adults may be important for a sustainable community.

Tao Jiang, Dewei Peng, Wei Shi et al.

AimsCytokine storm is closely related to the initiation and progression of sepsis, and the level of IL-6 is positively correlated with mortality and organ dysfunction. Sepsis-induced myocardial dysfunction (SIMD) is one of the major complications. However, the role of the IL-6/STAT3 signaling in the SIMD remains unclear.Methods and ResultsSeptic mice were induced by intraperitoneal injection of LPS (10 mg/kg). Echocardiography, cytokines detection, and histologic examination showed that sepsis mice developed cardiac systolic and diastolic dysfunction, increase of inflammatory cytokines in serum, activated STAT3 and TLR4/NFκB pathway in heart, and raised myocardial apoptosis, which were attenuated by IL-6/STAT3 inhibitor, Bazedoxifene. In vitro, we found that LPS decreased cell viability in a concentration-dependent manner and activated STAT3. Western blot and immunofluorescence results indicated that STAT3 phosphorylation induced by LPS was inhibited by Bazedoxifene. Bazedoxifene also suppressed LPS-induced IL-6 transcription. sIL-6R caused LPS-induced p-STAT3 firstly decreased and then significantly increased. More importantly, we found STAT3-knockdown suppressed LPS-induced expression of FUNDC1, a protein located in mitochondria-associated endoplasmic reticulum membranes (MAMs). Overexpression of STAT3 led to an increase in FUNDC1 expression. Dual-luciferase reporter assay was used to confirm that STAT3 was a potential transcription factor for FUNDC1. Moreover, we showed that LPS increased MAMs formation and intracellular Ca2+ levels, enhanced the expression of Cav1.2 and RyR2, decreased mitochondrial membrane potential and intracellular ATP levels, and promoted mitochondrial fragmentation, the expression of mitophagy proteins and ROS production in H9c2 cells, which were reversed by knockdown of FUNDC1 and IL-6/STAT3 inhibitor including Bazedoxifene and Stattic.ConclusionsIL-6/STAT3 pathway plays a key role in LPS-induced myocardial dysfunction, through regulating the FUNDC1-associated MAMs formation and interfering the function of ER and mitochondria. IL-6/STAT3/FUNDC1 signaling could be a new therapeutic target for SIMD.

Xinyu Zhang, Yueye Wang, Wei Wang et al.

Abstract Background Dual sensory impairment is affecting over 10% of older adults worldwide. However, the long-term effect of dual sensory impairment (DSI) on the risk of mortality remains controversial. We aim to investigate the impact of single or/and dual sensory impairment on the risk of mortality in a large population-based sample of the adult in the UK with 14-years of follow-up. Methods This population-based prospective cohort study included participants aged 40 and over with complete records of visual and hearing functions from the UK Biobank study. Measurements of visual and hearing functions were performed at baseline examinations between 2006 and 2010, and data on mortality was obtained by 2021. Dual sensory impairment was defined as concurrent visual and hearing impairments. Cox proportional hazards regression models were employed to evaluate the impact of sensory impairment (dual sensory impairment, single visual or hearing impairment) on the hazard of mortality. Results Of the 113,563 participants included in this study, the mean age (standard deviation) was 56.8 (8.09) years, and 61,849 (54.5%) were female. At baseline measurements, there were 733 (0.65%) participants with dual sensory impairment, 2,973 (2.62%) participants with single visual impairment, and 13,560 (11.94%) with single hearing impairment. After a follow-up period of 14 years (mean duration of 11 years), 5,992 (5.28%) participants died from all causes. Compared with no sensory impairment, dual sensory impairment was significantly associated with an estimated 44% higher hazard of mortality (hazard ratio: 1.44 [95% confidence interval, 1.11–1.88], p = 0.007) after multiple adjustments. Conclusions Individuals with dual sensory impairment were found to have an independently 44% higher hazard of mortality than those with neither sensory impairment. Timely intervention of sensory impairment and early prevention of its underlying causes should help to reduce the associated risk of mortality.

Yasaman Malekizadeh, Gareth Williams, Mark Kelson et al.

Abstract Background Stroke/thromboembolic events, infections, and death are all significantly increased by antipsychotics in dementia but little is known about why they can be harmful. Using a novel application of a drug repurposing paradigm, we aimed to identify potential mechanisms underlying adverse events. Methods Whole transcriptome signatures were generated for SH‐SY5Y cells treated with amisulpride, risperidone, and volinanserin using RNA sequencing. Bioinformatic analysis was performed that scored the association between antipsychotic signatures and expression data from 415,252 samples in the National Center for Biotechnology Information Gene Expression Omnibus (NCBI GEO) repository. Results Atherosclerosis, venous thromboembolism, and influenza NCBI GEO‐derived samples scored positively against antipsychotic signatures. Pathways enriched in antipsychotic signatures were linked to the cardiovascular and immune systems (eg, brain derived neurotrophic factor [BDNF], platelet derived growth factor receptor [PDGFR]‐beta, tumor necrosis factor [TNF], transforming growth factor [TGF]‐beta, selenoamino acid metabolism, and influenza infection). Conclusions These findings for the first time mechanistically link antipsychotics to specific cardiovascular and infectious diseases which are known side effects of their use in dementia, providing new information to explain related adverse events.

Ying Zhang, Xiao-Han Ding, Rongsheng Rao et al.

Aim: To determine the prevalence of pulmonary hypertension (PH) and its associated factors among end-stage renal disease (ESRD) patients who underwent maintenance dialysis.Methods: A total of 491 patients received echocardiography examinations and underwent pulmonary artery systolic pressure (PASP) assessments. A subgroup of 283 patients were subjected to plasma creatinine (Cr) and blood urea nitrogen concentration (BUN) tests, routine blood examinations and electrolyte analysis. First, we compared the differences in echocardiographic, Cr and BUN, blood routine and electrolyte parameters between PH and non-PH groups. The correlations between PASP and the parameters mentioned above were also analyzed. Furthermore, univariate and adjusted logistic regression analyses were performed to identify the independent associated factors.Results: The incidence of PH among ESRD patients who were treated with maintenance dialysis was 34.6%. Most of the echocardiographic parameters, including end-diastolic internal diameters of the left atrium, left ventricle, right atrium, and pulmonary artery, as well as interventricular septum mobility, left ventricular posterior wall mobility, fractional shortening, stroke volume and left ventricle ejection fraction (LVEF), were associated with PH. Furthermore, Mg2+ (p = 0.037) and Cl− (p = 0.043) were significantly associated with PASP. However, after adjustments were made in the regression analysis, only internal diameters of the left atrium, right atrium, and LVEF were independently associated with PH.Conclusion: PH is prevalent, with a relatively high incidence among ESRD patients who undergo maintenance dialysis. The sizes of the left and right atria as well as LVEF were independently associated with PH, but further cohort and basic mechanistic studies are needed to confirm this finding.

Hui‐Hui Liu, Ye‐Xuan Cao, Jing‐Lu Jin et al.

Background Although several studies have indicated that lipoprotein(a) is a useful prognostic predictor for patients following percutaneous coronary intervention (PCI), previous observations have somewhat been limited by either small sample size or short‐term follow‐up. Hence, this study aimed to evaluate the impact of lipoprotein(a) on long‐term outcomes in a large cohort of stable coronary artery disease patients after PCI. Methods and Results In this multicenter and prospective study, we consecutively enrolled 4078 stable coronary artery disease patients undergoing PCI from March 2011 to March 2016. They were categorized according to both the median of lipoprotein(a) levels and lipoprotein(a) values of <15 (low), 15 to 30 (medium), and ≥30 mg/dL (high). All patients were followed up for occurrence of cardiovascular events, including cardiovascular death, nonfatal myocardial infarction, and stroke. During an average of 4.9 years of follow‐up, 315 (7.7%) cardiovascular events occurred. The events group had significantly higher lipoprotein(a) levels than the nonevents group. Compared with the low lipoprotein(a) group, Kaplan–Meier analysis showed that the high lipoprotein(a) group had a significantly lower cumulative event‐free survival rate, and multivariate Cox regression analysis further revealed that the high lipoprotein(a) group had significantly increased cardiovascular events risk. Moreover, adding continuous or categorical lipoprotein(a) to the Cox model led to a significant improvement in C‐statistic, net reclassification, and integrated discrimination. Conclusions With a large sample size and long‐term follow‐up, our data confirmed that high lipoprotein(a) levels could be associated with a poor prognosis after PCI in stable coronary artery disease patients, suggesting that lipoprotein(a) measurements may be useful for patient risk stratification before selective PCI.