Obesity, Apolipoprotein E ε4, and Difficulties in Activities of Daily Living Among Older Adults: a 6-Year Follow-up Study

BACKGROUND: Obesity has been associated with increased physical limitations among older adults, although few studies have adjusted for important covariates. There is limited information about the relationship between apolipoprotein E (APOE) polymorphisms and physical limitations, and the findings have been inconsistent. PURPOSE: This study examined the longitudinal associations of obesity and APOE ε4 with difficulties in activities of daily living (ADLs) over a 6-year follow-up period controlling for multiple covariates. METHODS: Data were analyzed from the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan collected in 2000 and 2006, involving a cohort of 639 participants (mean age = 66). Body mass index (BMI) was used to define obesity at a baseline, and the APOE genotype was classified into an APOE ε4 carrier and non-carrier status. The combination of basic and instrumental activities of daily living (ADLs and IADLs) was used to define impaired ADLs. RESULTS: APOE ε4 carriers had greater difficulties in combined ADLs (incident rate ratio; IRR = 1.87, 95 % CI = 1.40-2.51) than non-carriers. Obese but not overweight adults had greater difficulties in activities of daily living (IRR = 1.59, 95 % CI = 1.20-2.10) compared with the normal/underweight group. Obese older adults without APOE ε4 had greater subsequent difficulties in ADLs than non-obese non-carriers. Among APOE ε4 carriers, obesity was not a significant risk factor for the development of impaired ADLs in older adults, indicating an interaction between genotype and obesity. CONCLUSIONS: The interaction between genotype and obesity phenotype adds new information about the determinants of physical impairment

Physical activity, smoking, and the incidence of clinically diagnosed insomnia

OBJECTIVE: This study was designed to examine the independent and combined associations of physical activity and smoking on the incidence of doctor-diagnosed insomnia using a nationally representative sample over seven years, taking into account other relevant covariates. METHODS: Participants aged 18 years or older in the 2005 Taiwan National Health Interview Survey (NHIS) with links to National Health Insurance (NHI) claim data between 2005 and 2012 and without diagnosed insomnia before 2005, were selected into this study (n = 12,728). Participants were classified as having insomnia with International Classification of Diseases, Ninth Revision (ICD-9) CM codes 307.41, 307.42, or 780.52. Self-reported smoking status and frequency, duration, and types of leisure-time and non−leisure-time physical activities were collected. Metabolic equivalent (MET) intensity levels for each activity were assigned, and weekly energy expenditure of each activity was calculated and summed. RESULTS: Inactive participants had a higher risk of incident insomnia [hazard ratio (HR) = 1.22, 95% confidence interval (CI) = 1.06–1.42, p = 0.007] than the active group, and ever-smokers were more likely to have incident insomnia than never smokers (HR = 1.45, 95% CI = 1.20–1.76, p < 0.001). Compared with the nonsmoker/active group, the ever-smoker/inactive group had a higher risk of incident insomnia (HR = 1.78, 95% CI = 1.41–2.25, p < 0.001). Sensitivity analyses excluding individuals diagnosed with other sleep disorders or mental disorders yielded similar results, with the ever-smoker/inactive group having the highest risk of insomnia. CONCLUSIONS: Inactive adults and smokers are at higher risk for incident insomnia, highlighting the importance of a healthy lifestyle and pointing to strategies such as encouraging smoking cessation and physical activity to avoid insomnia among adults

Prospective association between late-life physical activity and hospital care utilisation: a 7-year nationwide follow-up study

BACKGROUND: It is still equivocal whether there is a potential role of late-life physical activity in ameliorating the challenges of increasing healthcare expenditure due to the consequence of global population ageing. OBJECTIVE: this study aimed to examine the prospective association between physical activity and subsequent hospital care utilisation in older adults and to explore the optimal dose of physical activity required to reduce hospital care utilisation. DESIGN: this was a prospective cohort study based on the data from the Taiwan 2005 National Health Interview Survey, which were linked to the 2005-12 claims data from the National Health Insurance system. PARTICIPANTS: 1,760 older adults aged 65 or more. METHODS: the frequency, duration and intensity for physical activity were assessed, and total physical activity energy expenditure was estimated. The average annualised hospital care utilisation for the period 2006 through 2012, including number of hospitalisations, number of days in hospital and the costs of hospitalisation, were calculated. RESULTS: older adults engaging in at least moderate volume of physical activity (≥1,000 kcal/week) experienced fewer subsequent hospital admissions and fewer days in hospital than did sedentary individuals, after adjusting for covariates. Trends for reduced hospitalisation costs were also found. These associations persisted in sensitivity analyses, including tests of reverse causation. CONCLUSION: this study has provided evidence that older adults who are at least moderately active may minimise utilisation of hospital care services. The findings highlight the importance of maintaining a physically active lifestyle in later life

Prospective associations of exercise and depressive symptoms in older adults: the role of apolipoprotein E4

PURPOSE: Exercise is associated with reduced risk of depressive symptoms at older ages, while recent work suggests that the apolipoprotein E type 4 allele (APOE-e4) may increase risk. There are no studies of whether APOE-e4 moderates the relationship between exercise and later life depressive symptoms. This study aimed to explore whether the prospective associations between exercise and subsequent depressive symptoms were distinct between APOE-e4 carriers and non-carriers using nationwide data. METHODS: Data from 639 participants (mean age = 66.14, SD = 7.26) in 2000 with 6 years of follow-up were studied. Depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression Scale. Exercise and the APOE genotype were also assessed at baseline. Negative binomial regression models were conducted to examine the combined effects of exercise and APOE-e4 status on subsequent depressive symptoms when controlling for baseline depressive symptoms and other covariates. Sensitivity analyses to test for confounding, reverse causality, and attrition were conducted. RESULTS: Among APOE-e4 carriers, there was no significant difference in depressive symptoms between high active and low active groups. In contrast, high active APOE-e4 non-carriers had fewer depressive symptoms than low active APOE-e4 non-carriers. The beneficial effect of exercise on depressive symptoms is restricted to APOE-e4 non-carriers. Sensitivity analyses provided further support for the robustness of these findings. CONCLUSIONS: This is the first prospective study investigating whether APOE-e4 moderates the association between exercise and depressive symptoms. It proposes that genetic variation in APOE may influence the effect of exercise on depressive symptoms

Prospective relationship between objectively measured light physical activity and depressive symptoms in later life

BACKGROUND: The use of self-report measures of physical activity is a serious methodological weakness in many studies of physical activity and depressive symptoms. It is still equivocal whether light physical activity protects older adults from depressive symptoms. OBJECTIVE: This study aimed to explore whether objectively measured light physical activity, independent of sedentary and moderate-to-vigorous activity, is associated with a reduced risk of subsequent depressive symptoms in older adults. METHODS: This was a 2-year prospective cohort study. A total of 285 community-dwelling older adults aged 65 years or older were interviewed in 2012. A second wave of assessment was carried out in 2014 involving 274 (96.1%) participants. Time spent in physical activity at different intensities was assessed using triaxial accelerometers. Depressive symptoms were measured using the 15-item Geriatric Depression Scale. Negative binomial regression models with adjustment for baseline depressive symptoms, accelerometer wear time, socio-demographic variables, lifestyle behaviors, and chronic disease conditions were conducted. RESULTS: Time spent in moderate-to-vigorous and light physical activities were both inversely related to depressive symptoms at follow-up. Sedentary time was associated with an increased risk of subsequent depressive symptoms. When sedentary or moderate-to-vigorous activity were included in the multivariable-adjusted regression models with light physical activity simultaneously, only light physical activity remained significant. Sensitivity analyses for assessing confounding and reverse causation provided further support for the stability of these findings. CONCLUSION: Light physical activity, independent of sedentary and moderate-to-vigorous activity, is associated with a reduced risk of subsequent depressive symptoms in later life. Copyright © 2017 John Wiley & Sons, Ltd

Liposarcoma: exploration of clinical prognostic factors for risk based stratification of therapy

<p>Abstract</p> <p>Background</p> <p>Prognosis and optimal treatment strategies of liposarcoma have not been fully defined. The purpose of this study is to define the distinctive clinical features of liposarcomas by assessing prognostic factors.</p> <p>Methods</p> <p>Between January 1995 and May 2008, 94 liposarcoma patients who underwent surgical resection with curative intent were reviewed.</p> <p>Results</p> <p>Fifty patients (53.2%) presented with well differentiated, 22 (23.4%) myxoid, 15 (16.0%) dedifferentiated, 5 (5.3%) round cell, and 2 (2.1%) pleomorphic histology. With the median 14 cm sized of tumor burden, about half of the cases were located in the retroperitoneum (46.8%). Seventy two (76.6%) patients remained alive with 78.1%, and 67.5% of the 5- and 10-year overall survival (OS) rates, respectively. Low grade liposarcoma (well differentiated and myxoid) had a significantly prolonged OS and disease free survival (DFS) with adjuvant radiotherapy when compared with those without adjuvant radiotherapy (5-year OS, 100% vs 66.3%, P = 0.03; 1-year DFS, 92.9% <it>vs </it>50.0%, respectively, P = 0.04). Independent prognostic factors for OS were histologic variant (P = 0.001; HR, 5.1; 95% CI, 2.0 – 12.9), and margin status (P = 0.005; HR, 4.1; 95% CI, 1.6–10.5). We identified three different risk groups: group 1 (n = 66), no adverse factors; group 2, one or two adverse factors (n = 28). The 5-year OS rate for group 1, and 2 were 91.9%, 45.5%, respectively.</p> <p>Conclusion</p> <p>The histologic subtype, and margin status were independently associated with OS, and adjuvant radiotherapy seems to confer survival benefit in low grade tumors. Our prognostic model for primary liposarcoma demonstrated distinct three groups of patients with good prognostic discrimination.</p

Psychological wellbeing, physical impairments and rural aging in a developing country setting

<p>Abstract</p> <p>Background</p> <p>There has been very little research on wellbeing, physical impairments and disability in older people in developing countries.</p> <p>Methods</p> <p>A community survey of 1147 older parents, one per household, aged sixty and over in rural Thailand. We used the Burvill scale of physical impairment, the Thai Psychological Wellbeing Scale and the brief WHO Disability Assessment Schedule. We rated received and perceived social support separately from children and from others and rated support to children. We used weighted analyses to take account of the sampling design.</p> <p>Results</p> <p>Impairments due to arthritis, pain, paralysis, vision, stomach problems or breathing were all associated with lower wellbeing. After adjusting for disability, only impairment due to paralysis was independently associated with lowered wellbeing. The effect of having two or more impairments compared to none was associated with lowered wellbeing after adjusting for demographic factors and social support (adjusted difference -2.37 on the well-being scale with SD = 7.9, p < 0.001) but after adjusting for disability the coefficient fell and was non-significant. The parsimonious model for wellbeing included age, wealth, social support, disability and impairment due to paralysis (the effect of paralysis was -2.97, p = 0.001). In this Thai setting, received support from children and from others and perceived good support from and to children were all independently associated with greater wellbeing whereas actual support to children was associated with lower wellbeing. Low received support from children interacted with paralysis in being especially associated with low wellbeing.</p> <p>Conclusion</p> <p>In this Thai setting, as found in western settings, most of the association between physical impairments and lower wellbeing is explained by disability. Disability is potentially mediating the association between impairment and low wellbeing. Received support may buffer the impact of some impairments on wellbeing in this setting. Giving actual support to children is associated with less wellbeing unless the support being given to children is perceived as good, perhaps reflecting parental obligation to support adult children in need. Improving community disability services for older people and optimizing received social support will be vital in rural areas in developing countries.</p

Psychological Disorders, Cognitive Dysfunction and Quality of Life in Nasopharyngeal Carcinoma Patients with Radiation-Induced Brain Injury

PURPOSE:To evaluate factors affecting psychology, cognitive function and quality of life (QOL) of nasopharyngeal carcinoma (NPC) patients with radiation-induced brain injury (RI). METHODS AND MATERIALS:46 recurrence-free NPC patients with RI and 46 matched control patients without RI were recruited in our study. Subjective and objective symptoms of RI were evaluated with the LENT/SOMA systems. Psychological assessment was measured with Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). Montreal Cognitive Assessment (MoCA) was carried out in these patients for assessing their cognitive function. QOL was evaluated by means of WHOQOL BREF. RESULTS:Of the patients with RI, 39(84.8%) had depression and 40(87.0%) had anxiety. The patients with RI got higher scores both in SDS and SAS than those without RI (SDS, 63.48±8.11 vs. 58.67±7.52, p = 0.008; SAS, 67.36±10.41 vs. 60.34±9.76, p = 0.005). Score in MoCA of patients with RI was significantly lower than that of patients without RI (21.32±2.45 vs. 25.98±1.73, p<0.001). SAS was positive correlated with post-radiotherapy interval. Both SAS and SDS had a significantly positive correlation with the rank of SOMA, while MoCA had a significantly negative correlation with SOMA. Chemotherapy was a risk factor for cognitive dysfunction. In addition, patients with RI got significantly lower scores in physical health (16.50±11.05 vs. 35.02±10.43, p<0.001), psychological health (17.70±10.33 vs. 39.48±12.00, p<0.001) and social relationship (48.00±18.65 vs. 67.15±19.70, p<0.001) compared with those in patients without RI. Multiple linear regression analysis revealed that anxiety and cognitive impairment were significant predictors of global QOL. CONCLUSIONS:NPC patients with RI exhibit negative emotions, impaired cognitive function and QOL. The severity of clinical symptoms of RI plays an important role in both emotions and cognitive function. Anxiety and cognitive impairment are associated with decreased QOL

On the Resolution of Critical Flow Regions in Inviscid Linear And Nonlinear Instability Calculations

Numerical methods for tackling the inviscid instability problem are discussed. Convergence is demon- strated to be a necessary, but not a sufficient condition for accuracy. Inviscid flow physics set requirements regarding grid-point distribution in order for physically accurate results to be obtained. These requirements are relevant to the viscous problem also and are shown to be related to the resolution of the critical layers. In this respect, high-resolution nonlinear calculations based on the inviscid initial-boundary-value problem are presented for a model shear-layer flow, aiming at identification of the regions that require attention in the course of high-Reynolds-number viscous calculations. The results bear a remarkable resemblance with those pertinent to viscous flow, with a cascade of high-shear regions being shed towards the vortex-core centre as time progresses. In parallel, numerical instability related to the finite-time singularity of the nonlinear equations solved globally contaminates and eventually destroys the simulations, irrespective of resolution

Nilotinib and Imatinib Are Comparably Effective in Reducing Growth of Human Eosinophil Leukemia Cells in a Newly Established Xenograft Model

We developed a xenograft model of human Chronic Eosinophilic Leukemia (CEL) to study disease progression and remission-induction under therapy with tyrosine kinase inhibitors using imatinib and nilotinib as examples. The FIP1L1/PDGFRA+ human CEL cell lineEOL-1 was injected intravenously into scid mice, and MR imaging and FACS analysis of mouse blood samples were performed to monitor disease development and the effects of imatinib and nilotinib. Organ infiltration was analyzed in detail by immunohistochemistry after sacrifice. All animals developed CEL and within one week of therapy, complete remissions were seen with both imatinib and nilotinib, resulting in reduced total tumor volumes by MR-imaging and almost complete disappearance of EOL-1 cells in the peripheral blood and in tissues. The new model system is feasible for the evaluation of new tyrosine kinase inhibitors and our data suggest that nilotinib may be a valuable additional targeted drug active in patients with FIP1L1/PDGFRA+ CEL