Diabetes and Health Outcomes Among Older Taiwanese with Hip Fracture

Abstract Objective: Hip fracture tremendously impacts functional abilities for the elderly with high morbidity and mortality; recovery is compromised by co-morbidities. Diabetes mellitus is a common co-morbidity for the aging population, but little is known about the influence of diabetes on outcomes of the Asian elderly with hip fracture. Research Design and Methods: This study was a secondary analysis of data on 242 community-dwelling elders with hip fracture from three previous longitudinal studies. Sixty-one cases (25.2%) had diabetes. Outcomes were measured by the Chinese Barthel Index, Medical Outcomes Study Short Form-36 Taiwan version, and analyzed by the generalized estimating equation approach to examine how diabetes influenced hip-fractured elders' mortality, service utilization, mobility, daily activities, and health-related quality of life during the first 12 months after postsurgical discharge in Taiwan. Results: Hip-fractured elderly with diabetes had a significantly higher mortality rate (22.6% vs. 10.3%, p=0.03) during the first year following discharge, and significantly higher readmission rate (10.0% vs. 2.5%, p=0.04) from the first to third month following discharge than those without diabetes. After controlling for covariates, elderly participants without diabetes had an overall 2.2 times (confidence interval [CI]=1.15?4.21) greater odds of recovery in walking ability and better reported general health (?=9.33; p=0.01) and physical functioning (?=7.26; p=0.02) than those with diabetes during the first year after discharge. Conclusions: Diabetes negatively influenced outcomes of elderly patients with hip fracture. The results may provide a reference for developing interventions for hip-fractured elders with diabetes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98472/1/rej%2E2011%2E1308.pd

Functional recovery of older people with hip fracture: does malnutrition make a difference?

Aim To report a study of the effects of protein‐energy malnutrition on the functional recovery of older people with hip fracture who participated in an interdisciplinary intervention. Background It is not clear whether protein‐energy malnutrition is associated with worse functional outcomes or it affects the interdisciplinary intervention program on the functional recovery of older people with hip fracture. Design A randomized experimental design. Methods Data were collected between 2002–2006 from older people with hip fracture ( N  = 162) in Taiwan. The generalized estimating equations approach was used to evaluate the effect of malnutrition on the functional recovery of older people with hip fracture. Results The majority of older patients with hip fracture were malnourished (48/80, 60% in the experimental group vs. 55/82, 67% in the control group) prior to hospital discharge. The results of the generalized estimating equations analysis demonstrated that subjects suffering from protein‐energy malnutrition prior to hospital discharge appeared to have significantly worse performance trajectories for their activities of daily living, instrumental activities of daily living, and recovery of walking ability compared with those without protein‐energy malnutrition. In addition, it was found that the intervention is more effective on the performance of activities of daily living and recovery of walking ability in malnourished patients than in non‐malnourished patients. Conclusion Healthcare providers should develop a nutritional assessment/management system in their interdisciplinary intervention program to improve the functional recovery of older people with hip fracture.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99041/1/jan12027.pd

Interdisciplinary intervention decreases cognitive impairment for older Taiwanese with hip fracture: 2‐year follow‐up

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/101759/1/gps3945.pd

Fucosyltransferase 1 and 2 play pivotal roles in breast cancer cells.

FUT1 and FUT2 encode alpha 1, 2-fucosyltransferases which catalyze the addition of alpha 1, 2-linked fucose to glycans. Glycan products of FUT1 and FUT2, such as Globo H and Lewis Y, are highly expressed on malignant tissues, including breast cancer. Herein, we investigated the roles of FUT1 and FUT2 in breast cancer. Silencing of FUT1 or FUT2 by shRNAs inhibited cell proliferation in vitro and tumorigenicity in mice. This was associated with diminished properties of cancer stem cell (CSC), including mammosphere formation and CSC marker both in vitro and in xenografts. Silencing of FUT2, but not FUT1, significantly changed the cuboidal morphology to dense clusters of small and round cells with reduced adhesion to polystyrene and extracellular matrix, including laminin, fibronectin and collagen. Silencing of FUT1 or FUT2 suppressed cell migration in wound healing assay, whereas FUT1 and FUT2 overexpression increased cell migration and invasion in vitro and metastasis of breast cancer in vivo. A decrease in mesenchymal like markers such as fibronectin, vimentin, and twist, along with increased epithelial like marker, E-cadherin, was observed upon FUT1/2 knockdown, while the opposite was noted by overexpression of FUT1 or FUT2. As expected, FUT1 or FUT2 knockdown reduced Globo H, whereas FUT1 or FUT2 overexpression showed contrary effects. Exogenous addition of Globo H-ceramide reversed the suppression of cell migration by FUT1 knockdown but not the inhibition of cell adhesion by FUT2 silencing, suggesting that at least part of the effects of FUT1/2 knockdown were mediated by Globo H. Our results imply that FUT1 and FUT2 play important roles in regulating growth, adhesion, migration and CSC properties of breast cancer, and may serve as therapeutic targets for breast cancer

Apoptotic Cell Death and Inhibition of Wnt/β-Catenin Signaling Pathway in Human Colon Cancer Cells by an Active Fraction (HS7) from Taiwanofungus camphoratus

Aberrant activation of Wnt/β-catenin signaling plays an important role in the development of colon cancer. HS7 is an active fraction extracted from Taiwanofungus camphoratus, which had been widely used as complementary medicine for Taiwan cancer patients in the past decades. In this study, we demonstrated the effects of HS7 on the growth inhibition, apoptosis induction, and Wnt/β-catenin signaling suppression in human colon cancer cells. HS7 significantly inhibited proliferation of HT29, HCT116, and SW480 colon cancer cells in a dose- and time-dependent manner. The apoptosis induction was evidenced by DNA fragmentation and subG1 accumulation, which was associated with increased Bax/Bcl-2 ratio, activation of caspase-3 and cleavage of PARP. By using Tcf-dependent luciferase activity assay, HS7 was found to inhibit the β-catenin/Tcf transcriptional activities. In addition, HS7 strongly suppressed the binding of Tcf complexes to its DNA-binding site shown in electrophoretic mobility shift assay. This inhibition was further confirmed by the decreased protein levels of Tcf-4 and β-catenin. The β-catenin/Tcf downstream target genes, such as survivin, c-myc, cyclin D1, MMP7, and MT1-MMP involved in apoptosis, invasion, and angiogenesis were also diminished as well. These results indicate that Taiwanofungus camphoratus may provide a benefit as integrative medicine for the treatment of colon cancer

Effects of interventions on trajectories of health-related quality of life among older patients with hip fracture: a prospective randomized controlled trial

Abstract Background Health-related quality of life (HRQoL) has been used to assess subjects’ prognosis and recovery following hip fracture. However, evidence is mixed regarding the effectiveness of interventions to improve HRQoL of elders with hip fracture. The purposes of this study were to identify distinct HRQoL trajectories and to evaluate the effects of two care models on these trajectories over 12 months following hip-fracture surgery. Methods For this secondary analysis, data came from a randomized controlled trial of subjects with hip fracture receiving three treatment care models: interdisciplinary care (n = 97), comprehensive care (n = 91), and usual care (n = 93). Interdisciplinary care consisted of geriatric consultation, discharge planning, and 4 months of in-home rehabilitation. Comprehensive care consisted of interdisciplinary care plus management of malnutrition and depressive symptoms, fall prevention, and 12 months of in-home rehabilitation. Usual care included only in-hospital rehabilitation and occasional discharge planning, without geriatric consultation and in-home rehabilitation. Mental and physical HRQoL were measured at 1, 3, 6, and 12 months after discharge by the physical component summary scale (PCS) and mental component summary scale (MCS), respectively, of the Medical Outcomes Study Short Form 36, Taiwan version. Latent class growth modeling was used to identify PCS and MCS trajectories and to evaluate how they were affected by the interdisciplinary and comprehensive care models. Results We identified three quadratic PCS trajectories: poor PCS (n = 103, 36.6 %), moderate PCS (n = 96, 34.2 %), and good PCS (n = 82, 29.2 %). In contrast, we found three linear MCS trajectories: poor MCS (n = 39, 13.9 %), moderate MCS (n = 84, 29.9 %), and good MCS (n = 158, 56.2 %). Subjects in the comprehensive care and interdisciplinary care groups were more likely to experience a good PCS trajectory (b = 0.99, odds ratio [OR] = 2.69, confidence interval [CI] = 7.24–1.00, p = 0.049, and b = 1.32, OR = 3.75, CI = 10.53–1.33, p = 0.012, respectively) than those who received usual care. However, neither care model improved MCS. Conclusions The interdisciplinary and comprehensive care models improved recovery from hip fracture by increasing subjects’ odds for following a trajectory of good physical functioning after hospitalization. Trial registration ClinicalTrials.gov ( NCT01350557 )http://deepblue.lib.umich.edu/bitstream/2027.42/134528/1/12891_2016_Article_958.pd