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OBJECTIVE: Hearing impairment in older adults may affect cognitive function and increase the risk of dementia. Most cognitive tests are delivered auditorily, and individuals with hearing loss may fail to hear verbal instructions. Greater listening difficulty and fatigue in acoustic conditions may impact test performance. This study aimed to examine the effect of decreased audibility on cognitive screening test performance in older adults. METHOD: Older adults (n = 63) with different levels of hearing loss completed a standard auditory Mini-Mental State Examination test and a written version of the test. RESULTS: Individuals with moderate to moderately severe hearing loss (41-70 dB) performed significantly better on the written (24.34 ± 4.90) than on the standard test (22.55 ± 6.25), whereas scores were not impacted for mild hearing loss (less than 40 dB). CONCLUSION: Hearing evaluations should be included in cognitive assessment, and test performance should be carefully interpreted in individuals with hearing loss to avoid overestimating cognitive decline.

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Frailty is a common condition among older adults with hip fracture. In our study analyzing National Inpatient Sample data, frailty was found to be associated with up to six times increase in in-patient mortality, 55% increased length of hospital stay, and 29% increase in hospital cost. INTRODUCTION: Hip fracture is a significant public health issue posing adverse health outcomes and substantial economic burden to patients and society. Frailty is a prevalent geriatric condition associated with poor clinical outcome among older adults. The association between hip fracture and frailty on both clinical and economic outcomes at the national level has not been estimated. We aimed to determine the association between frailty and in-hospital mortality, length of hospital stay (LOS), and total hospital cost among older patients aged ≥ 65 years who underwent surgery for hip fracture. METHODS: We did an analysis of administrative data using the National Inpatient Sample (NIS) data from 2016 and 2017. Our analysis included data on 29,735 hospitalizations. We first conducted a descriptive analysis of the patient characteristics (demographics and clinical) and hospital-related factors. Three multivariable regression analysis models were then used to determine independent associations between frailty and in-hospital mortality, LOS, and total hospital cost. All three models were adjusted for patients' demographic and clinical characteristics and hospital-related factors. RESULTS: Moderate and high frailty risk were associated with higher odds of death (OR = 2.94 and 95% CI 1.91-4.51 and OR = 5.99 and 95% CI 3.79-9.47), increased LOS (17% and 55%, p < 0.0001), and higher total hospital cost (7% and 29%, p < 0.0001) respectively compared to low frailty risk. CONCLUSION: Frailty was associated with mortality, LOS, and hospital cost after adjusting for patient demographic, clinical, and hospital-related factors. Further research is needed to explore what pre-surgical measures can be assessed to mitigate in-hospital mortality and hospital cost in frail older patients hospitalized for hip fracture surgery.

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HIV-infected men under the age of 50 years had a lower bone mass compared to that of HIV-uninfected men. Lower CD4 T cell counts, independent of whether antiretroviral therapy (ART) was used, were associated with lower BMD. HIV-infected patients with low CD4 T cell counts may need follow-up and intervention regarding bone health, including younger patients. INTRODUCTION: HIV-infected patients have a low bone mineral density (BMD) owing to multifactorial interaction between common osteoporosis risk factors and HIV-related factors, including chronic inflammation and ART. Although HIV infection and ART might affect bone metabolism, little data is available for patients aged under 50 years. We aimed to investigate the association of HIV infection-induced low CD4 T cell counts and ART with BMD in men aged under 50 years. METHODS: We performed an age- and body mass index-matched case-control study. BMD values of HIV-infected and HIV-uninfected men (< 50 years) were compared, and HIV-infected men were stratified by CD4 T cell counts and ART use. RESULTS: After adjusting confounders, HIV-infected men with CD4 T cell counts ≥ 500 cells/µL (n = 28) and < 500 cells/µL (n = 139) had lower BMD at the femoral neck (FN, p < 0.001) and total hip (TH, p < 0.001) than HIV-uninfected men (n = 167). HIV-infected men with CD4 T cell counts < 500/µL had lower BMD at the lumbar spine (LS, p = 0.034) than those with counts of ≥ 500 cells/µL, but not at FN and TH. The CD4 T cell count (γ = 0.169, p = 0.031) was positively correlated with BMD at LS. There was no significant difference in the BMD (p = 0.499-> 0.999) between the ART-naïve (n = 75) and ART-user group (n = 92). CONCLUSIONS: Despite their relatively younger age, HIV-infected men had a lower BMD than HIV-uninfected men. Lower CD4 T cell counts, irrespective of ART, might result in lower bone mass.

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We report the transfer printing of GaN-based microscale vertical-type light-emitting diodes (µ-VLEDs) using a functional layer and a biomimetic stamp. An oxide-based functional layer is inserted onto the structure of a µ-VLED and used to separate the chip from the µ-VLED wafer by absorbing the pulse of a UV pulse laser during pick-up of the transfer printing process. Polydimethylsiloxane (PDMS)-based biomimetic stamps have been fabricated to mimic the gecko lizard cilia for improved adhesion and repeatability. The biomimetic stamp has an adhesion force of 25.6 N/cm2, which is 12 times the adhesion of a flat stamp; an adhesion force of 10 N/cm2 or more was maintained after 100,000 repeated adhesion tests. A flexible 10 × 10 prototype array on a polyimide substrate was fabricated, and its bending test results indicated that the strain effect on the forward voltage and the output power was less than 1%. The stable bending test results of the prototype indicate that µ-VLEDs using biomimetic stamps allow the necessary stability for practical transfer printing.

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The plasma n-3 fatty acid level was 26.2% lower in patients with osteoporotic hip fracture than in those with osteoarthritis. In all patients, n-3 fatty acid was positively associated with bone mineral density and inversely associated with tartrate-resistant acid phosphatase-5b level in bone marrow aspirates, reflecting the bone microenvironment. INTRODUCTION: Despite the potential beneficial role of n-3 fatty acid (FA) on bone metabolism, the specific mechanisms underlying these effects in humans remain unclear. Here, we assessed whether the plasma n-3 level, as an objective indicator of its status, is associated with osteoporosis-related phenotypes and bone-related markers in human bone marrow (BM) samples. METHODS: This was a case-control and cross-sectional study conducted in a clinical unit. n-3 FA in the blood and bone biochemical markers in the BM aspirates were measured by gas chromatography/mass spectrometry and immunoassay, respectively. BM fluids were collected from 72 patients who underwent hip surgery because of either osteoporotic hip fracture (HF; n = 28) or osteoarthritis (n = 44). RESULTS: After adjusting for confounders, patients with HF had 26.2% lower plasma n-3 levels than those with osteoarthritis (P = 0.006), and each standard deviation increment in plasma n-3 was associated with a multivariate-adjusted odds ratio of 0.40 for osteoporotic HF (P = 0.010). In multivariate analyses including all patients, a higher plasma n-3 level was associated with higher bone mass at the lumbar spine (ß = 0.615, P = 0.002) and total femur (ß = 0.244, P = 0.045). Interestingly, the plasma n-3 level was inversely associated with the tartrate-resistant acid phosphatase-5b level (ß = - 0.633, P = 0.023), but not with the bone-specific alkaline phosphatase level, in BM aspirates. CONCLUSIONS: These findings provide clinical evidence that n-3 FA is a potential inhibitor of osteoclastogenesis that favors human bone health.

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A new species of co-endangered tick, Ixodes heathi n. sp., is described from specimens of the nymph collected on the critically endangered mountain pygmy possum (Burramys parvus Broom) from the alpine region of Victoria, Australia. Its biology is discussed along with strategies for its conservation.

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Despite ethnic differences in cortisol sensitivity, only one study in Caucasians has assessed trabecular bone score (TBS) in patients with subclinical hypercortisolism (SH). We showed that both subtle cortisol excess and reduced adrenal androgen may contribute to impaired bone quality in Asian women with SH. INTRODUCTION: One study in Caucasians has assessed trabecular bone score (TBS), an index of bone microstructure, in adrenal incidentaloma (AI) patients with subclinical hypercortisolism (SH). There are ethnic differences in cortisol sensitivities between Caucasian and Asian populations. We investigated the associations of cortisol and the adrenal androgen dehydroepiandrosterone-sulfate (DHEA-S) with TBS in AI patients with SH, adrenal Cushing's syndrome (CS), and nonfunctional AI (NFAI). METHODS: We measured TBS, cortisol levels after the overnight 1 mg dexamethasone suppression test (1 mg DST), and cortisol/DHEA-S in 61 patients with SH (30 men; 31 women), 19 with adrenal CS (4 men; 15 women), and 355 with NFAI (213 men; 142 women). RESULTS: After adjusting for confounders, the serum cortisol level after 1 mg DST was inversely correlated with TBS in men (ß = -0.133, P = 0.045) and women (ß = - 0.140, P = 0.048). Higher cortisol/DHEA-S ratio was associated with lower TBS in women (ß = - 0.252, P < 0.001), but not men. This inverse association of cortisol/DHEA-S ratio in women remained statistically significant after adjusting for the serum cortisol level after 1 mg DST (ß = - 0.221, P = 0.008). Compared with women with NFAI, women with SH had 2.2% lower TBS (P = 0.040). Deteriorated bone microstructure (TBS < 1.230) was associated with the serum cortisol level after 1 mg DST (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.04-4.53) and cortisol/DHEA-S ratio (OR, 2.05; 95% CI, 1.03-4.08). CONCLUSIONS: Subtle cortisol excess in both genders and reduced DHEA-S, especially in women, may contribute to impaired bone quality in Asian patients with SH.

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Type 2 diabetes (T2DM) has strong heritability but genetic models to explain heritability have been challenging. We tested deep neural network (DNN) to predict T2DM using the nested case-control study of Nurses' Health Study (3326 females, 45.6% T2DM) and Health Professionals Follow-up Study (2502 males, 46.5% T2DM). We selected 96, 214, 399, and 678 single-nucleotide polymorphism (SNPs) through Fisher's exact test and L1-penalized logistic regression. We split each dataset randomly in 4:1 to train prediction models and test their performance. DNN and logistic regressions showed better area under the curve (AUC) of ROC curves than the clinical model when 399 or more SNPs included. DNN was superior than logistic regressions in AUC with 399 or more SNPs in male and 678 SNPs in female. Addition of clinical factors consistently increased AUC of DNN but failed to improve logistic regressions with 214 or more SNPs. In conclusion, we show that DNN can be a versatile tool to predict T2DM incorporating large numbers of SNPs and clinical information. Limitations include a relatively small number of the subjects mostly of European ethnicity. Further studies are warranted to confirm and improve performance of genetic prediction models using DNN in different ethnic groups.

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Within Australia, koala over-abundance has become a serious problem in some areas resulting in significant damage to native forests through defoliation. An over-abundant Victorian koala population was surveyed for ticks in the autumn of 2016. During the survey 1036 ticks were collected from 158 koalas. All ticks collected were identified as Ixodes tasmani. Tick prevalence, infestation intensity and on-host sex ratios were calculated for the population. An overview of the ticks and mites associated with koalas in Australia is also presented.

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For the first time, infestation of the Australian emu by a native tick is recorded based on an engorged adult female specimen of the southern paralysis tick (Ixodes cornuatus) taken from a captive emu at Healesville sanctuary, Victoria, Australia. Tick paralysis in Australian birds is discussed.

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BACKGROUND: The presence of white matter hyperintensity (WMH) and lacunar infarct are recognized as risk factors of dementia, stroke and mortality. It is undetermined whether visceral adipose tissue (VAT) area is associated with an increased risk of cerebral small vessel disease. We explored whether VAT area was responsible for cerebral small vessel disease through the identification of WMH and lacunar infarct. SUBJECTS: A total of 2046 subjects free of cerebrovascular disease who underwent brain magnetic resonance imaging and abdominal fat computed tomography during a general health check-up were enrolled. RESULTS: The prevalence of cerebral WMH was 37.7%. Subjects with WMH had greater VAT area and higher BMI and waist circumference than those without WMH, although significant differences in subcutaneous adipose tissue (SAT) area were not shown. Subjects with lacunar infarct also had significantly greater VAT area and higher waist circumference and BMI than those without lacunar infarct. Multivariate analyses adjusted for age, sex, diabetes, hypertension, smoking and alcohol, showed VAT area was an independent risk factor of cerebral WMH (odds ratio (OR): 1.13, 95% confidence interval (CI): 1.02-1.24, P=0.016), whereas waist circumference and SAT area were not significantly associated with the risk of WMH. Likewise, VAT area was also independently associated with lacunar infarct (OR: 1.38, 95% CI: 1.06-1.81, P=0.018), whereas the other anthropometric measures were not related with lacunar infarct. CONCLUSIONS: VAT has a significant association with cerebral small vessel disease, which was defined as WMH or lacunar infarct. Visceral obesity can be a potential therapeutic target for the prevention of cerebral small vessel disease.

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Two new species, Trachylestes barrowensis sp. nov. from Barrow Island, Western Australia and T. queenslandensis sp. nov. from southeastern Queensland are described, and a key for their separation from other known species of the Australian endemic genus Trachylestes Stål, 1868 (Hemiptera: Heteroptera: Reduviidae: Harpactorinae) is given.

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Abies koreana is an endemic and rare species from Korea and is classified as endangered by the International Union for Conservation of Nature. Although the genetic diversity assessment for current population of A. koreana needs to be performed urgently, no microsatellite markers have been developed for this species. In the present study, we developed 22 novel polymorphic microsatellite loci and the characteristics of these loci were determined in A. koreana as well as in Abies nephrolepis, the most closely related species, and these loci were compared with previously reported microsatellite markers developed for the Abies genus. Genomic sequence (161 Mbp; 325,776 reads) was obtained from one individual of A. koreana using Roche 454 GS-FLX Titanium sequencing and 19,258 repeat motifs were identified from it. A total of 288 primer pairs with high copy numbers of di-repeat motifs were evaluated for amplification in A. koreana and A. nephrolepis. A total of 71 primer pairs successfully amplified fragments, of which 22 showed polymorphisms in A. koreana and A. nephrolepis. The average expected diversity was 0.767 and 0.717 in A. koreana and A. nephrolepis, respectively; these heterozygosity levels were moderate compared to the previously reported microsatellite loci from Abies species. This is the first set of microsatellite markers developed for A. koreana as well as A. nephrolepis and further population genetic studies of both species and genetic delimitation can be carried out for the species conservation and management.

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Salivary glands have an essential secretory function for maintaining oral and overall health. The epithelial compartment of the gland is composed of several highly specialized cell types that cooperate to secrete and deliver saliva to the oral cavity. The mouse submandibular gland has been used as a model for major salivary glands in human. The secretory complex in this model is composed of 2 secretory compartments, including acini and granular ducts connected by intercalated ducts. Contractile myoepithelial cells surround the secretory complex to facilitate salivary flow. Whether differentiated cells in the secretory complex are maintained by self-duplication or contribution from stem cells has remained an open question. Here, in analyzing the expression of basal cytokeratin (K) 14 in the secretory complex, we discovered a subset of K14(+) ductal cells in the intercalated ducts of the adult gland. These cells are distinct from the K14-expressing basal/myoepithelial cells, proliferate at a significantly higher rate than any other epithelial cell type in the gland, and reside in a spatially defined domain within the intercalated duct. Using inducible genetic lineage tracing, we show that K14(+) ductal cells represent a long-lived yet cycling population of stem cells that are established during development and contribute to the formation and maintenance of the granular ducts throughout life. Our data provide direct evidence for the existence of stem cells contributing to homeostasis of salivary glands, as well as new insights into glandular pathobiology.

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The involvement of the nicotinamide adenine dinucleotide (NAD(+)) salvage pathway in cancer cell survival is poorly understood. Here we show that the NAD(+) salvage pathway modulates cancer cell survival through the rarely mutated tumour suppressor p73. Our data show that pharmacological inhibition or knockdown of nicotinamide phosphoribosyltransferase (NAMPT), a rate-limiting enzyme in the NAD(+) salvage pathway, enhances autophagy and decreases survival of cancer cells in a p53-independent manner. Such NAMPT inhibition stabilizes p73 independently of p53 through increased acetylation and decreased ubiquitination, resulting in enhanced autophagy and cell death. These effects of NAMPT inhibition can be effectively reversed using nicotinamide mononucleotide (NMN), the enzymatic product of NAMPT. Similarly, knockdown of p73 also decreases NAMPT inhibition-induced autophagy and cell death, whereas overexpression of p73 alone enhances these effects. We show that the breast cancer cell lines (MCF-7, MDA-MB-231 and MDA-MB-468) harbour significantly higher levels of NAMPT and lower levels of p73 than does the normal cell line (MCF-10A), and that NAMPT inhibition is cytotoxic exclusively to the cancer cells. Furthermore, data from 176 breast cancer patients demonstrate that higher levels of NAMPT and lower levels of p73 correlate with poorer patient survival, and that high-grade tumours have significantly higher NAMPT/p73 mRNA ratios. Therefore, the inverse relationship between NAMPT and p73 demonstrable in vitro is also reflected from the clinical data. Taken together, our studies reveal a new NAMPT-p73 nexus that likely has important implications for cancer diagnosis, prognosis and treatment.

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BACKGROUND: The purpose of this report is twofold: first, to detail our operative approach to rectocele repair, and second, to report on the outcomes. METHODS: Transverse incision transvaginal rectocele repair combined with levatorplasty and biological graft placement is detailed using hand-drawn sketches and intraoperative photographs. All patients with symptoms of functional constipation and non-emptying rectocele operated on from May 2007 to March 2013 at our institution were enrolled in this study. Data from a prospectively maintained database were retrospectively analyzed. Preoperative and postoperative functional outcomes were studied using a validated 31-point obstructed defecation (OD) scoring system. Follow-up was 1 year. RESULTS: Twenty-three patients underwent the procedure. The mean age of patients was 55 years (range 28-79 years). The OD severity score improved from the preoperative mean of 21.6 to postoperative mean of 5.5 (p = 0.001). Three out of four patients with initial symptoms of dyspareunia (75%) reported significant improvement in dyspareunia, while 2 out of 19 patients without initial symptoms of dyspareunia (11%) reported mild dyspareunia following the repair. One patient (4%) required operative drainage of a hematoma. Another patient (4%) developed symptomatic recurrence which was confirmed radiologically. CONCLUSIONS: In properly selected patients, the technique described leads to significant improvement in symptoms of OD and low recurrence without an increased rate of dyspareunia.

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AIM: The effects of beta-blockers in pediatric and congenital heart disease (CHD) patients suffering from heart failure are controversial. We performed a meta-analysis to determine whether beta-blockers are effective for heart failure in pediatric and CHD patients. METHODS: We searched for clinical trials focusing on clinical on clinical and ventricular functional/dimensional changes after beta-blocker therapy in PubMed (from its inception to August 2013) and bibliographies of identified studies. Studies investigating any of three beta blockers (carvedilol, bisoprolol, and extended release metoprolol succinate) which are known to be effective in adult patients with heart failure were included. RESULTS: Of the 158 screened, 17 (N.=476) fulfilled the study criteria and were analyzed. Beta-blockers were associated with significant improvements in left ventricular (LV) ejection fraction (EF) (12.47%; 95% CI, 10.36 to 14.61), fraction shortening (5.75%; 95% CI, 4.42 to 7.08), LV end-diastolic dimension (-2.91 mm; 95% CI, -5.46 to -0.36), and LV systolic dimension (-4.03 mm; 95% CI, -6.81 to -1.25). No significant change in the pooled mean difference of the right ventricular (RV) EF (3.50%; P=0.08) was observed. However, the RV EF in the untreated group showed a deteriorating trend (-3%), which was different from the trend in the treatment group. There was a significant reduction in the incidence of clinical worsening (odds ratio, 2.15; 95% CI, 1.27 to 3.66). CONCLUSION: Beta-blocker therapy was associated with a significant improvement of echocardiographic parameters in patients with systemic LV failure. However, the use of beta-blockers did not provide significant benefits in terms of improving the EF in patients with RV failure. Nonetheless, beta-blockers may be effective to prevent the clinical deterioration of pediatric and CHD patients with heart failure.

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OBJECTIVE: Wider application of CT angiography (CTA) improves the diagnosis of acute pulmonary embolism (PE). It also permits the visualisation of saddle embolism (SE), namely thrombi, which are located at the bifurcation of the main pulmonary artery. The aim of this study was to assess the prevalence of SE and whether SE predicts a complicated clinical course in patients with non-high-risk PE. METHODS: In total, 297 consecutive patients with non-high-risk PE confirmed using CTA in the emergency department were studied. The presence of SE and its ability to predict the occurrence of major adverse events (MAEs) within 1 month were determined. RESULTS: Of the 297 patients, 27 (9.1%) had an SE. The overall mortality at 1 month was 12.5%; no significant difference was observed between the SE and non-SE groups (18.5% vs 11.9%, p=0.32). However, patients with SE were more likely to receive thrombolytic therapy (29.6% vs 8.1%, p<0.01) and had significantly more MAEs (59.3% vs 25.6%, p<0.01). CONCLUSION: At the time of diagnosis, SE, as determined using CTA, is associated with the development of MAE within 1 month. It may be a simple method for risk stratification of patients with non-high-risk PE. ADVANCES IN KNOWLEDGE: The prognosis of patients with SE, especially those who are haemodynamically stable, is unclear. This study shows that patients with SE, determined with CTA, is associated with the development of MAE.

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