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Background Previous studies suggest that poor sleep quality or abnormal sleep duration may be associated with frailty. Here we test the associations of sleep disturbances with both frailty and pre-frailty in an elderly population. Methods Participants included 1726 community-dwelling elders aged 70–87 years. Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep disturbances. Frailty was defined using phenotype criteria. Logistic regression models were used to estimate odds ratio of the associations. Results The average PSQI score was 5.4 (SD, 3.1). Overall 43.6% of the participants had poor sleep quality (PSQI> 5), 8.2% had night sleep time ≤ 5 h, and 27.8% had night sleep time ≥ 9 h. The prevalence of frailty and pre-frailty was 9.2 and 52.8%, respectively. The proportions of PSQI> 5 increased with the severity of frailty status (robust: pre-frail: frail, 34.5%: 48%: 56.1%, P  < 0.001). After adjustment for multiple potential confounders, poor sleep quality (PSQI> 5) was associated with higher odds of frailty (OR = 1.78, 95% CI 1.19–2.66) and pre-frailty (OR = 1.51, 95% CI 1.20–1.90). Sleep latency, sleep disturbance, and daytime dysfunction components of PSQI measurements were also associated with frailty and pre-frailty. In addition, sleep time 9 h/night was associated with higher odds of frailty and pre-frailty. Conclusions We provided preliminary evidences that poor sleep quality and prolonged sleep duration were associated with being frailty and pre-frailty in an elderly population aged 70–87 years. The associations need to be validated in other elderly populations.

INTRODUCTION Various associations between social factors and motoric cognitive risk syndrome (MCR) have been reported. However, whether social frailty (integrated from multiple social factors) is associated with MCR is still unclear. METHODS We included 4657 individuals without MCR at Round 1 of the NHATS as the discovery sample, and 3075 newly recruited individuals from Round 5 of the NHATS as the independent validation sample. Social frailty was assessed by five social items. MCR was defined as the presence of both subjective cognitive complaints and slow gait speed in individuals without dementia or mobility disability. RESULTS Compared with normal individuals, those with social frailty had higher risk of incident MCR (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.34–1.84). Each additional unfavorable social item was associated with an increased risk of MCR (HR: 1.32, 95% CI: 1.22–1.43). DISCUSSION Social frailty was associated with an increased risk of incident MCR in older adults. Highlights Various associations between social factors and motoric cognitive risk syndrome (MCR) have been reported. Social frailty that integrated from multiple social factors was associated with an increased risk of incident MCR. Social frailty should be included in the early screening of individuals to identify those at higher risk of MCR.

Background Ovarian cancer is one of the most common gynecologic cancers and has high mortality rate due to the lack of early diagnosis method and efficient therapeutic agents. circCELSR1 is up-regulated in ovarian cancer, but its role and mechanisms in ovarian cancer are unclear. Methods Gene expression of circCELSR1, miR-598 and BRD4 in ovarian cells was examined by qRT-PCR. Protein level was determined by Western blotting. Bioinformatic analysis and luciferase assay determined the molecular binding among circCELSR1, miR-598 and BRD4 3′ UTR. Cell proliferation, migration, invasion and apoptosis were determined by colony formation, wound healing assay, transwell assay and flow cytometry analysis, respectively. An abdominal cavity metastasis nude mice model was used to determine the in vivo function of circCELSR1. Results circCELSR1 and BRD4 were promoted, but miR-598 was suppressed in various ovarian cancer cells. circCELSR1 bound to miR-598 and promoted expression of its downstream target BRD4. Knockdown of circCELSR1 suppressed proliferation, migration, invasion and epithelial-mesenchymal transition (EMT), but promoted apoptosis in ovarian cancer cells, and these effects were reversed by miR-598 inhibition or BRD4 overexpression. circCELSR1 inhibition decreased the expression of BRD4 and its downstream proliferation/migration related genes by targeting miR-598. Furthermore, knockdown of circCELSR1 suppressed ovarian cancer growth and metastasis in nude mice. Conclusion Knockdown of circCELSR1 inhibited BRD4-mediated proliferation/migration related signaling via sponging miR-598, thereby repressing ovarian cancer progression. This study provides a new regulatory mechanism of ovarian cancer may facilitate the development of therapeutic agents for ovarian cancer.

Little is known about the adverse effects of frailty transitions. In this study, we aimed to characterize the transitions between frailty states and examine their associations with the type of death among older adults in China, a developing country with a rapidly growing aging population. We used data of 11,165 older adults (aged 65-99 years) from the 2002 and 2005 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Overall, 44 health deficits were used to construct frailty index (FI; range: 0-1), which was then categorized into a three-level variable: nonfrail (FI ≤0.10), prefrail (0.10< FI ≤0.21), and frail (FI >0.21). Outcome was four types of death based on bedridden days and suffering state (assessed in the 2008 wave of CLHLS). During the 3-year period, 3,394 (30.4%) participants had transitioned between different frailty states (nonfrail, prefrail, and frail), one-third transitioned to death, and one-third remained in previous frailty states. Transitions to greater frailty (ie, \"worsening\") were more common than transitions to lesser frailty (ie, \"improvement\"). Among four categories of frailty transitions, \"worsening\" and \"remaining frail\" had increased risks of painful death, eg, with odds ratios of 1.92 (95% confidence interval [CI] =1.41, 2.62) and 4.75 (95% CI =3.32, 6.80), respectively, for type 4 death (ie, ≥30 bedridden days with suffering before death). This large sample of older adults in China supports that frailty is a dynamic process, characterized by frequent types of transitions. Furthermore, those who remained frail had the highest likelihood of experiencing painful death, which raises concerns about the quality of life in frail populations.

INTRODUCTION Motoric cognitive risk syndrome (MCR) is a predementia syndrome that is characterized by cognitive complaints and slow gait. Cardiometabolic multimorbidity (CMM) is associated with an increased risk of dementia. However, the relationship between CMM and MCR is still unclear. METHODS We included 4744 participants (aged 65+ years) without MCR at baseline from the National Health and Aging Trends Study (NHATS), who were followed‐up from 2011 to 2018. CMM was defined as the presence of two or more cardiometabolic diseases (including diabetes mellitus, heart disease, and stroke). RESULTS CMM was significantly associated with an increased risk of MCR (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.13–1.75) in fully adjusted models. Consistent results were observed from stratified analyses of different subgroups. Increasing numbers of cardiometabolic diseases were dose‐dependently associated with increased MCR risk (HR 1.33, 95% CI 1.20–1.48). DISCUSSION CMM is associated with an increased risk of MCR in older adults. HIGHLIGHTS Motoric cognitive risk syndrome (MCR) is a predementia syndrome characterized by slow gait speed and cognitive complaints. Cardiometabolic multimorbidity was associated with an increased MCR risk. An increased number of cardiometabolic diseases were dose‐dependently associated with increased MCR risk.

Background:Laparoscopic debulking surgery can effectively remove ovarian cysts and alleviate clinical symptoms, yet it is also associated with a high rate of postoperative nausea and vomiting (PONV). This study aimed to identify the risk factors for PONV occurrence in patients undergoing laparoscopic surgery for benign ovarian cyst debulking. Additionally, it examined the impact of zero-opioid general anesthesia on reducing PONV to improve the prognosis of patients.Methods:We retrospectively analyzed 334 patients who underwent laparoscopic ovarian cyst debulking. The patients were divided into treatment groups and control groups depending on the differences in their treatment strategies. Propensity score matching was performed in a 1:1 ratio according to age, race, and body mass index (BMI); the final number of patients in each group was 100. The clinician performed an ultrasound-guided bilateral transversus abdominis plane block in the treatment group, while the control group received fentanyl before surgery at a dose of 4 μg/kg. Differences in the clinical characteristics of patients between the groups were analyzed, and the incidence of PONV was compared. Independent risk factors for PONV occurrence were analyzed using binary logistic regression.Results:The incidence of PONV was lower in the treatment group (18%) than in the control group (47%). The use of opioid anesthetics (odds ratio (OR) = 4.258, p = 0.028), the anesthesia duration (OR = 1.098, p = 0.025), history of motion sickness (OR = 4.305, p = 0.015), history of PONV (OR = 5.314, p = 0.009), postoperative analgesic pump use (OR = 6.688, p = 0.001), preoperative fluid volume (OR = 0.967, p = 0.000), preoperative use of 5-hydroxytryptamine (OR = 0.982, p = 0.016), and postoperative use of 5-hydroxytryptamine for 12 h (OR = 1.008, p = 0.015) were independent predictive factors for PONV occurrence (p < 0.05).Conclusion:The occurrence of PONV in patients with ovarian cysts is associated with a history of PONV and a history of motion sickness. Implementing a zero-opioid general anesthesia technique can significantly reduce PONV incidence, contributing to improved patient prognoses.

Diallyl trisulfide （DATS）, a garlic organosulfide, has shown excellent chemopreventive potential. Cisplatin （DDP） is widely used to treat solid malignant tumors, but causing serious side effects. In the current study, we attempted to elucidate the chemopreventive mechanisms of DATS in human gastric cancer BGC-823 cells in vitro, and to investigate whether DATS could enhance the anti-tumor efficacy of DDP and improve quality of life in BGC-823 xenograft mice in vivo. Treatment with DATS （25-400 pmol/L） dose-dependently inhibited the viability of BGC-823 cells in vitro with an IC5o of 115.2＋4.3 pmol/L after 24 h drug exposure. DATS （50-200 pmol/L） induced cell cycle arrest at G2/M phase in BGC-823 cells, which correlated with significant accumulation of cyclin A2 and B1. DATS also induced BGC-823 cell apoptosis, which was accompanied by the modulation of Bcl-2 family members and caspase cascade activation. In BGC-823 xenograft mice, administration of DATS （20-40 mg.kg-1.d-1, ip） dose-dependently inhibited tumor growth and markedly reduced the number of Ki-67 positive cells in tumors. Interestingly, combined administration of DATS （30 mg.kg-1.d-1, ip） with DDP （5 mg/kg, every 5 d, ip） exhibited enhanced anti-tumor activity with fewer side effects. We showed that treatment of BGC-823 cells with DATS in vitro and in vivo significantly activated kinases such as p38 and JNK/MAPK and attenuated the Nrf2/Akt pathway. This study provides evidence that DATS exerts anticancer effects and enhances the antitumor efficacy of DDP, making it a novel candidate for adjuvant therapy for gastric cancer.

Coal is a major contributor to the global emission of nitrogen oxides (NOx). The NOx formation during coal utilization typically derives from the thermal decomposition of N-containing compounds (e.g., pyrrolic groups). NH3 and HCN are common precursors of NOx from the decomposition of N-containing compounds. The existence of H2O has significant influences on the pyrrole decomposition and NOx formation. In this study, the effects of H2O on pyrrole pyrolysis to form NOx precursors HCN and NH3 are investigated using the density functional theory (DFT) method. The calculation results indicate that the presence of H2O can lead to the formation of both NH3 and HCN during pyrrole pyrolysis, while only HCN is formed in the absence of H2O. The initial interaction between pyrrole and H2O determines the N products. NH3 will be formed when H2O attacks the C2 position of pyrrole with its hydroxyl group. On the contrary, HCN will be generated instead of NH3 when H2O attacks the C3 position of pyrrole with its hydroxyl group. In addition, the DFT calculations clearly indicate that the formation of NH3 will be promoted by H2O, whereas the formation of HCN is inhibited.

Background Acute exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) contributes significantly to mortality among patients with COPD in Intensive care unit (ICU). This study aimed to develop a nomogram to predict 30-day mortality among AECOPD patients in ICU. Methods In this retrospective cohort study, we extracted AECOPD patients from Medical Information Mart for Intensive Care III (MIMIC-III) database. Multivariate logistic regression based on Akaike information criterion (AIC) was used to establish the nomogram. Internal validation was performed by a bootstrap resampling approach with 1000 replications. The discrimination and calibration of the nomogram were evaluated by Harrell’s concordance index (C-index) and Hosmer–Lemeshow (HL) goodness-of-fit test. Decision curve analysis (DCA) was performed to evaluate its clinical application. Results A total of 494 patients were finally included in the study with a mean age of 70.8 years old. 417 (84.4%) patients were in the survivor group and 77 (15.6%) patients were in the non-survivor group. Multivariate logistic regression analysis based on AIC included age, pO 2 , neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index (PNI), invasive mechanical ventilation and vasopressor use to construct the nomogram. The adjusted C-index was 0.745 (0.712, 0.778) with good calibration (HL test, P  = 0.147). The Kaplan–Meier survival curves revealed a significantly lower survival probability in the high-risk group than that in the low-risk group ( P  < 0.001). DCA showed that nomogram was clinically useful. Conclusion The nomogram developed in this study could help clinicians to stratify AECOPD patients and provide appropriate care in clinical setting.

In order to understand the catalytic effects of inherent inorganic elements in biomass on the pyrolysis mechanism of lignin, density functional theory with a Gaussian method of M06-2X and basic set of 6-31 + G(d,p) was employed to simulate the pyrolysis pathways of a β -O-4 type lignin dimer model compound (1-methoxy-2-(4-methoxyphenethoxy)benzene) catalyzed by NaCl and KCl which are major inorganic constituents of biomass at microscale level. The calculation results indicate that cations (Na + and K + ) in alkali metal chlorides are facile to combine with the oxygen-containing functional groups in the lignin dimer model compound. Both cations increase the C β −O bond length and shorten the C α –C β bond length, which will further affect their bond dissociation energies. In the initial pyrolysis process of the lignin dimer model compound, NaCl and KCl can promote the C β –O homolytic reaction and concerted decomposition reaction, while restrain the C α –C β homolytic reaction. Therefore, the lignin dimer model compound decomposes mainly through the concerted decomposition and C β –O homolytic mechanisms under NaCl and KCl catalytic pyrolysis conditions, producing 1-methoxy-4-vinylbenzene, 1-ethyl-4-methoxybenzene, 2-methoxyphenol, catechol and 2-hydroxybenzaldehyde, among which NaCl and KCl have inhibitory effect on 2-hydroxybenzaldehyde, but have promoting effect on the other pyrolytic products.