Factors Associated With Leisure Participation Among the Elderly Living in Long-term Care Facilities

SummaryBackgroundA lack of participation in leisure activities often leads to depression in the elderly. This study investigated the factors impacting leisure participation among the elderly living in long-term care facilities.MethodsThis cross-sectional study recruited 309 individuals older than 65 years from six long-term care facilities located in the Taipei area. Structured in-person questionnaires were administered to assess their demographic characteristics, general self-rated health status, leisure constraints, and leisure participation.ResultsThe average frequency of leisure participation was 27.20 ± 12.48 points. The top five most popular leisure activities were watching television, walking, chatting, reading, and participating in religious activities. Elderly subjects who tended to be female, have religious beliefs, have a high school education level, be married, perceive themselves in better health, demonstrate better cognitive function and have higher scores on activities of daily living and instrumental activities of daily living scales were more likely to participate in leisure activities (p < 0.05). In contrast, those who were older, had stayed in the facility for a longer time period and had more leisure constraints were less likely to participate in leisure activities (p < 0.05). Overall, the predictive factors for leisure participation included religious beliefs, educational level, cognitive skill, instrumental activities of daily living score, depression, personal inner constraints, and structural constraints. The entire model was significant (F = 11.03, p < 0.001).ConclusionBased on the self-reported interests, health status and level of cognitive skill of elderly residents, long-term care facilities should arrange appropriate leisure activities to prevent depression and to improve quality of life

MiniZero: Comparative Analysis of AlphaZero and MuZero on Go, Othello, and Atari Games

This paper presents MiniZero, a zero-knowledge learning framework that supports four state-of-the-art algorithms, including AlphaZero, MuZero, Gumbel AlphaZero, and Gumbel MuZero. While these algorithms have demonstrated super-human performance in many games, it remains unclear which among them is most suitable or efficient for specific tasks. Through MiniZero, we systematically evaluate the performance of each algorithm in two board games, 9x9 Go and 8x8 Othello, as well as 57 Atari games. For two board games, using more simulations generally results in higher performance. However, the choice of AlphaZero and MuZero may differ based on game properties. For Atari games, both MuZero and Gumbel MuZero are worth considering. Since each game has unique characteristics, different algorithms and simulations yield varying results. In addition, we introduce an approach, called progressive simulation, which progressively increases the simulation budget during training to allocate computation more efficiently. Our empirical results demonstrate that progressive simulation achieves significantly superior performance in two board games. By making our framework and trained models publicly available, this paper contributes a benchmark for future research on zero-knowledge learning algorithms, assisting researchers in algorithm selection and comparison against these zero-knowledge learning baselines. Our code and data are available at https://rlg.iis.sinica.edu.tw/papers/minizero.Comment: Submitted to IEEE Transactions on Games, under revie

Clustering Heart Rate Dynamics Is Associated with β-Adrenergic Receptor Polymorphisms: Analysis by Information-Based Similarity Index

Background: Genetic polymorphisms in the gene encoding the β-adrenergic receptors (β -AR) have a pivotal role in the functions of the autonomic nervous system. Using heart rate variability (HRV) as an indicator of autonomic function, we present a bottom-up genotype–phenotype analysis to investigate the association between β -AR gene polymorphisms and heart rate dynamics. Methods: A total of 221 healthy Han Chinese adults (59 males and 162 females, aged 33.6610.8 years, range 19 to 63 years) were recruited and genotyped for three common β-AR polymorphisms: β$_1$-AR Ser49Gly, β$_2$-AR Arg16Gly and β$_2$-AR Gln27Glu. Each subject underwent two hours of electrocardiogram monitoring at rest. We applied an information-based similarity (IBS) index to measure the pairwise dissimilarity of heart rate dynamics among study subjects. Results: With the aid of agglomerative hierarchical cluster analysis, we categorized subjects into major clusters, which were found to have significantly different distributions of β$_2$-AR Arg16Gly genotype. Furthermore, the non-randomness index, a nonlinear HRV measure derived from the IBS method, was significantly lower in Arg16 homozygotes than in Gly16 carriers. The non-randomness index was negatively correlated with parasympathetic-related HRV variables and positively correlated with those HRV indices reflecting a sympathovagal shift toward sympathetic activity. Conclusions: We demonstrate a bottom-up categorization approach combining the IBS method and hierarchical cluster analysis to detect subgroups of subjects with HRV phenotypes associated with β-AR polymorphisms. Our results provide evidence that β$_2$-AR polymorphisms are significantly associated with the acceleration/deceleration pattern of heart rate oscillation, reflecting the underlying mode of autonomic nervous system control

Large aortic aneurysm mimicking a cardiac tumor

<p>Abstract</p> <p>Introduction</p> <p>Extrinsic left atrial compression caused by a displaced, crooked descending thoracic aorta is rare. This anomaly may mimic primary cardiac tumors or metastatic neoplasms from the first look.</p> <p>Case presentation</p> <p>We reported a 78-year-old woman presented to our emergency room with back pain, increased exercise intolerance and intermittent angina. She also had one syncopal event 1 month ago and gastric cancer post gastrectomy history. Subsequent chest plain film showed no mediastinum widening.</p> <p>Two-dimensional echocardiography was performed and revealed a heterogeneous mass as large as 2.3 × 2.4 cm occupying the left atrium (LA). Three-dimensional echocardiography vividly demonstrated that LA was constrained between the aortic valve (AV) and a luminal structure with pulsatile character suggestive of the aorta.</p> <p>Conclusions</p> <p>We successfully demonstrated the detailed structure and location of an anomalous descending aorta on the oblique imaging plane of RT-3DE, which may not be readily available by traditional 2D method.</p

Improving Success Rates of Percutaneous Coronary Intervention for Chronic Total Occlusion at a Rural Hospital in East Taiwan

SummaryBackgroundWe aimed to report the results of percutaneous coronary intervention for chronic total occlusion (CTO) in a remote hospital of southeast Taiwan that does not have on-site coronary artery bypass graft support and has insufficient medical resources.MethodsFrom 2006 to 2009, we identified 96 patients who underwent percutaneous coronary intervention and whose coronary angiogram showed CTO lesions. On-site cardiovascular surgeons were unavailable from 2006 to 2009.ResultsThe success rate (test for trend, p = 0.02) and numbers of guidewires used (test for trend, p = 0.59) significantly increased from 2006 to 2009, and the procedural time reduced significantly (test for trend, p = 0.001). The volume of contrast media injected decreased, although this result was not statistically significant (p = 0.70).ConclusionOur experience in managing CTO lesions substantially improved and the procedural time reduced over 4 years, even when constrained by a relative shortage of medical resources

Neuron Regeneration and Proliferation Effects of Danshen and Tanshinone IIA

This study evaluates the proliferative effects of danshen and its monomer extract, tanshinone IIA, on Schwann cell proliferation. A piece of silicone rubber was guided across a 15-mm gap in the sciatic nerve of a rat. This nerve gap was then filled with different concentrations of danshen (0–100 mg/mL). The results showed that danshen increased the expressions of uPA, cyclin D1, E and ERK, JNK, and P38 MAP kinases via the FGF-2 signaling pathway in a dose-dependent manner. RSC96, Schwann cells were also administered with danshen (0, 20, 40, 60, 80, and 100 μg/mL) and tanshinone IIA (0, 2, 4, 6, 8, and 10 μg/mL). In lower concentrations, danshen and tanshinone IIA exhibited an apparent effect on Schwann cells. Similar effects were also demonstrated in the FGF-2-uPA regulating cascade and cell cycle proliferative protein results. Schwann cell migration was elevated as well. We used MAPK-signaling chemical inhibitors and identified the proliferative effects of danshen and tanshinone IIA as MAPK-signaling dependent. The results from the in vitro systems indicate that danshen and tanshinone IIA can be used to induce Schwann cell proliferation, and in vivo results potentially suggest that danshen and tanshinone IIA might enhance neuron regeneration

Compensatory guaiacyl lignin biosynthesis at the expense of syringyl lignin in 4CL1-knockout poplar

The lignin biosynthetic pathway is highly conserved in angiosperms, yet pathway manipulations give rise to a variety of taxon-specific outcomes. Knockout of lignin-associated 4-coumarate:CoA ligases (4CLs) in herbaceous species mainly reduces guaiacyl (G) lignin and enhances cell wall saccharification. Here we show that CRISPR-knockout of 4CL1 in poplar (Populus tremula x alba) preferentially reduced syringyl (S) lignin, with negligible effects on biomass recalcitrance. Concordant with reduced S-lignin was downregulation of ferulate 5-hydroxylases (F5Hs). Lignification was largely sustained by 4CL5, a low-affinity paralog of 4CL1 typically with only minor xylem expression or activity. Levels of caffeate, the preferred substrate of 4CL5, increased in line with significant upregulation of caffeoyl shikimate esterase1. Upregulation of caffeoyl-CoA O-methyltransferase1 and downregulation of F5Hs are consistent with preferential funneling of 4CL5 products toward G-lignin biosynthesis at the expense of S-lignin. Thus, transcriptional and metabolic adaptations to 4CL1-knockout appear to have enabled 4CL5 catalysis at a level sufficient to sustain lignification. Finally, genes involved in sulfur assimilation, the glutathione-ascorbate cycle, and various antioxidant systems were upregulated in the mutants, suggesting cascading responses to perturbed thioesterification in lignin biosynthesis

Association of Female Menopause With Atrioventricular Mechanics and Outcomes

BACKGROUND: Despite known sex differences in cardiac structure and function, little is known about how menopause and estrogen associate with atrioventricular mechanics and outcomes. OBJECTIVE: To study how, sex differences, loss of estrogen in menopause and duration of menopause, relate to atrioventricular mechanics and outcomes. METHODS: Among 4051 asymptomatic adults (49.8 ± 10.8 years, 35%women), left ventricular (LV) and left atrial (LA) mechanics were assessed using speckle-tracking. RESULTS: Post-menopausal (vs. pre-menopausal) women had similar LV ejection fraction but reduced GLS, reduced PALS, increased LA stiffness, higher LV sphericity and LV torsion (all p < 0.001). Multivariable analysis showed menopause to be associated with greater LV sphericity (0.02, 95%CI 0.01, 0.03), higher indexed LV mass (LVMi), lower mitral e’, lower LV GLS (0.37, 95%CI 0.04–0.70), higher LV torsion, larger LA volume, worse PALS (∼2.4-fold) and greater LA stiffness (0.028, 95%CI 0.01–0.05). Increasing years of menopause was associated with further reduction in GLS, markedly worse LA mechanics despite greater LV sphericity and higher torsion. Lower estradiol levels correlated with more impaired LV diastolic function, impaired LV GLS, greater LA stiffness, and increased LV sphericity and LV torsion (all p < 0.05). Approximately 5.5% (37/669) of post-menopausal women incident HF over 2.9 years of follow-up. Greater LV sphericity [adjusted hazard ratio (aHR) 1.04, 95%CI 1.00–1.07], impaired GLS (aHR 0.87, 95%CI 0.78–0.97), reduced peak left atrial longitudinal strain (PALS, aHR 0.94, 95%CI 0.90–0.99) and higher LA stiffness (aHR 10.5, 95%CI 1.69–64.6) were independently associated with the primary outcome of HF hospitalizations in post-menopause. Both PALS < 23% (aHR:1.32, 95%CI 1.01–3.49) and GLS < 16% (aHR:5.80, 95%CI 1.79–18.8) remained prognostic for the incidence of HF in post-menopausal women in dichotomous analyses, even after adjusting for confounders. Results were consistent with composite outcomes of HF hospitalizations and 1-year all-cause mortality as well. CONCLUSION: Menopause was associated with greater LV/LA remodeling and reduced LV longitudinal and LA function in women. The cardiac functional deficit with menopause and lower estradiol levels, along with their independent prognostic value post-menopause, may elucidate sex differences in heart failure further