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Abstract Introduction: Living donor kidney transplantation is considered the ideal renal replacement therapy because it has a lower complication rate and allows an efficient response to the high demand for grafts in the healthcare system. Careful selection and adequate monitoring of donors is a key element in transplantation. Individuals at greater risk of developing kidney dysfunction after nephrectomy must be identified. Objective: To identify risk factors associated with a renal compensation rate (CR) below 70% 12 months after nephrectomy. Methods: This observational retrospective longitudinal study included living kidney donors followed up at the Lower Amazon Regional Hospital between 2016 and 2022. Data related to sociodemographic variables, comorbid conditions and kidney function parameters were collected. Results: The study enrolled 32 patients. Fourteen (43.75%) had a CR < 70% 12 months after kidney donation. Logistic regression found obesity (Odds Ratio [95%CI]: 10.6 [1.7-65.2]), albuminuria (Odds Ratio [95%CI]: 2.41 [1.2-4.84]) and proteinuria (Odds Ratio [95%CI]: 1.14 [1.03-1.25]) as risk factors. Glomerular filtration rate was a protective factor (Odds Ratio [95% CI]: 0.92 [0.85-0.99]). Conclusion: Obesity, albuminuria and proteinuria adversely affected short-term renal compensation rate. Further studies are needed to uncover the prognostic implications tied to these risk factors. Our findings also supported the need for careful individualized assessment of potential donors and closer monitoring of individuals at higher risk.

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Resumo Introdução: O transplante de rim de doador vivo é considerado a terapia renal substitutiva ideal por oferecer menor taxa de complicações e possibilitar uma resposta eficiente à grande demanda por enxertos no sistema de saúde. A seleção criteriosa e o acompanhamento adequado dos doadores constituem um pilar fundamental dessa modalidade terapêutica, sendo essencial a identificação dos indivíduos em maior risco de disfunção renal pós-nefrectomia. Objetivo: Identificar fatores de risco para uma Taxa de Compensação (TC) da função renal inferior a 70% 12 meses após a nefrectomia. Métodos: Estudo observacional, retrospectivo e longitudinal conduzido com doadores de rim vivo acompanhados no Hospital Regional do Baixo Amazonas entre 2016 e 2022. Foram coletados dados correspondentes a variáveis sociodemográficas, comorbidades e parâmetros de função renal. Resultados: Foram incluídos 32 pacientes na amostra final. Destes, 14 (43,75%) obtiveram TC < 70% 12 meses após a doação. A regressão logística identificou a obesidade (Odds Ratio [IC95%]: 10.6 [1.7-65.2]), albuminúria (Odds Ratio [IC95%]: 2.41 [1.2-4.84]) e proteinúria (Odds Ratio [IC95%]: 1.14 [1.03-1.25]) como fatores de risco. A taxa de filtração glomerular atuou como fator de proteção (Odds Ratio [IC95%]: 0.92 [0.85-0.99]). Conclusão: Obesidade, albuminúria e proteinúria demonstraram impacto negativo na taxa de compensação renal em curto prazo, o que reitera a necessidade de estudos acerca das implicações prognósticas desses fatores. Além disso, reforça-se a necessidade de avaliação cuidadosa e individualizada dos possíveis doadores, com acompanhamento rigoroso, especialmente para indivíduos de maior risco.

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gLiving materials can achieve unprecedented function by combining synthetic materials with the wide range of cellular functions. Of interest are situations where the critical properties of individual abiotic and biotic elements improve via their combination. For example, integrating electroactive bacteria into conjugated polyelectrolyte (CPE) hydrogels increases biocurrent production. One observes more efficient electrical charge transport within the CPE matrix in the presence of Shewanella oneidensis MR-1 and more current per cell is extracted, compared to traditional biofilms. Here, the origin of these synergistic effects are examined. Transcriptomics reveals that genes in S. oneidensis MR-1 related to bacteriophages and energy metabolism are upregulated in the composite material. Fluorescent staining and rheological measurements before and after enzymatic treatment identified the importance of extracellular biomaterials in increasing matrix cohesion. The synergy between CPE and S. oneidensis MR-1 thus arises from initially unanticipated changes in matrix composition and bacteria adaption within the synthetic environment.

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This study investigates the impacts of health shocks among older individuals on the dynamics of their living arrangements in Europe and the United States. Exploiting unpredicted health shocks, we use an event-study difference-in-differences approach to demonstrate that health shocks increase difficulties with activities of daily living and instrumental activities of daily living, thereby increasing the need for care. Our findings indicate that health shocks raise the probability of nursing home residency and co-residence with adult children by 0.7 and 1.4 percentage points in Europe, and by 2.1 and 1.8 percentage points in the U.S., respectively. Further analyses reveal that more generous long-term care public policies correlate with a higher probability of nursing home residency and a lower probability of co-residing with adult children, highlighting the significant role of public policies in household responses to health shocks. Additionally, we find that health shocks negatively impact adult children's labor supply, particularly in the U.S.

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BACKGROUND: The automatic detection of activities of daily living (ADL) is necessary to improve long-term home-based monitoring of Parkinson's disease (PD) symptoms. While most body-worn sensor algorithms for ADL detection were developed using laboratory research systems covering full-body kinematics, it is now crucial to achieve ADL detection using a single body-worn sensor that remains commercially available and affordable for ecological use. AIM: to detect and segment Walking, Turning, Sitting-down, and Standing-up activities of patients with PD using a Smartwatch positioned at the ankle. METHOD: Twenty-two patients living with PD performed a Timed Up and Go (TUG) task three times before engaging in cleaning ADL in a simulated free-living environment during a 3 min trial. Accelerations and angular velocities of the right or left ankle were recorded in three dimensions using a Smartwatch. The TUG task was used to develop detection algorithms for Walking, Turning, Sitting-down, and Standing-up, while the 3 min trial in the free-living environment was used to test and validate these algorithms. Sensitivity, specificity, and F-scores were calculated based on a manual segmentation of ADL. RESULTS: Sensitivity, specificity, and F-scores were 96.5%, 94.7%, and 96.0% for Walking; 90.0%, 93.6%, and 91.7% for Turning; 57.5%, 70.5%, and 52.3% for Sitting-down; and 57.5%, 72.9%, and 54.1% for Standing-up. The median of time difference between the manual and automatic segmentation was 1.31 s for Walking, 0.71 s for Turning, 2.75 s for Sitting-down, and 2.35 s for Standing-up. CONCLUSION: The results of this study demonstrate that segmenting ADL to characterize the mobility of people with PD based on a single Smartwatch can be comparable to manual segmentation while requiring significantly less time. While Walking and Turning were well detected, Sitting-down and Standing-up will require further investigation to develop better algorithms. Nonetheless, these achievements increase the odds of success in implementing wearable technologies for PD monitoring in ecological environments.

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Actividades Cotidianas , Algoritmos , Tobillo , Enfermedad de Parkinson , Caminata , Dispositivos Electrónicos Vestibles , Humanos , Enfermedad de Parkinson/fisiopatología , Masculino , Femenino , Anciano , Tobillo/fisiopatología , Caminata/fisiología , Persona de Mediana Edad , Fenómenos Biomecánicos/fisiología

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BACKGROUND: Associations between HbA1c and adverse outcomes in ischemic and hemorrhagic stroke have been confirmed. It is still unclear whether HbA1c is related to the activities of daily living (ADL) score in complex chronic patients (CCP) with and without intracerebral hemorrhage (ICH). AIM: The associations between HbA1c and ADL (Barthel score) in CCP with ICH and without ICH were evaluated, respectively. METHODS: We have analyzed data from a previous cohort study involving in 3594 CCPs without a ICH history at baseline, who were followed up for 5 years to assess ICH episode. RESULTS: One hundred sixty-one ICH case were detected in a total of 3594 patients during the period of follow up for 5 years. Our nonlinear analysis suggested positive trends on the association between HBA1c and Barthel score in ICH and non-ICH patients, respectively. The multivariate linear regression analysis showed that elevated HbA1c was positively associated with a higher Barthel score among all study population (ß = 1.25, 95% CI: 0.92, 1.59; P < 0.0001) with adjusted age and sex. Among non-ICH patients, increased HbA1c was still positively associated with an increased Barthel score (ß = 1.24, 95% CI: 0.90, 1.58; P < 0.001). However, HbA1c appeared to have no any relationship with Barthel score in ICH patients (ß = 1.87, 95% CI: -0.07, 3.82; P = 0.0613) after adjustment for age and sex. By additionally using sensitivity analysis, we still observed that the strong relationship was still existed in non-ICH patients (ß = 0.90, 95% CI: 0.56, 1.24; P < 0.001) but not in ICH patients (ß = 1.88, 95% CI: -0.10, 3.86; P = 0.0649). CONCLUSION: We observed for the first time that elevated HbA1c is associated with better ADL in CCPs without ICH but not in those with ICH. This interesting discovery contradicts the traditional adverse effects of elevated HbA1c.

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Actividades Cotidianas , Hemorragia Cerebral , Hemoglobina Glucada , Humanos , Masculino , Femenino , Hemorragia Cerebral/sangre , Hemoglobina Glucada/metabolismo , Hemoglobina Glucada/análisis , Anciano , Persona de Mediana Edad , Enfermedad Crónica , Estudios de Cohortes , Anciano de 80 o más Años , Estudios de Seguimiento

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Catatonia is characterized by the loss of voluntary control over the workings of the mind and body. It disrupts daily life by manifesting as idle posture, heightened muscle tone, and repetitive purposeless movements. However, specific physiotherapy methods addressing these symptoms are yet to be established. This case report describes a 63-year-old man hospitalized for schizophrenia who was then diagnosed with stuporous catatonia based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria, characterized by catalepsy, mutism, and difficulty performing daily activities. This case report aimed to evaluate the effectiveness of a specific muscle relaxation technique, squeeze-hold (SH), in treating catatonia associated with schizophrenia and its impact on daily activities. The patient exhibited catalepsy, mutism, and difficulty in performing daily activities. The SH technique employed temporarily obstructs muscle blood flow to induce ischemia, resulting in the relaxation of vascular smooth muscle due to CO2 retention. Furthermore, shear stress upon reperfusion stimulates nitric oxide production in the vascular endothelium, enhancing blood flow. Following weekly SH on the bilateral thighs, the muscle tone in the lower extremities was alleviated within two weeks, and the patient no longer required a wheelchair by the eighth week. In addition, responsiveness to verbal commands improved. As muscle tone in the lower limbs improved, the patient regained ambulation, and his improved responsiveness facilitated independent eating during activities of daily living (ADLs), potentially enhancing motivation and spontaneity. These findings suggest that muscle tone relaxation due to enhanced blood flow and increased CO2 concentration from blood flow restriction may have promoted ß-endorphin secretion, thereby improving symptoms via brain-derived neurotrophic factor expression through PGC-1α activation. In conclusion, the SH muscle relaxation technique effectively alleviated catatonic symptoms, and improved muscle tone and daily functioning in patients with schizophrenia-associated catatonia. These findings suggest that this physiotherapy approach may be a valuable addition to catatonia treatment, potentially contributing to physical and psychiatric rehabilitation. This case report illustrates the efficacy of a muscle-tone-focused treatment approach in physical therapy for catatonia and posits its contribution to the reacquisition of psychiatric function and ADLs.

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BACKGROUND: Various factors affect the improvement of range of motion (ROM) after total knee arthroplasty (TKA). However, there are few reports specific to cruciate-sacrificing rotating platform (CSRP) TKA. In this study, factors affecting postoperative ROM improvement of CSRP TKA were investigated. METHODS: The study included 79 patients with knee osteoarthritis who underwent unilateral CSRP TKA at our institution. The group with an improvement of 5° or more (Δflexion angle) than the preoperative was defined as the good Δflexion group (38 knees), and that with less than 5° was defined as the poor Δflexion group (41 knees). The assessments were performed one day before and one year after surgery. Factors including rest and walking pain, knee flexion and extension angle, isometric knee extension strength, the five subscales of Knee injury and Osteoarthritis Outcome Score (KOOS), α, ß, γ and δ angles, femoro-tibial angle (FTA), and condylar twist angle were assessed. Unpaired t-test, Mann-Whitney U test, and Chi-square test were used to test differences between the good and poor Δflexion groups. Multiple logistic regression examined the association between each factor and the dependent variables (good Δflexion or poor Δflexion). RESULTS: Significant differences in the preoperative knee flexion, postoperative knee flexion, preoperative knee extension, and postoperative knee extension angles, postoperative KOOS pain and activity of daily living, ß, ɤ angles were observed between the good and poor Δflexion groups. The model Chi-squared test revealed that the ɤ angle was significantly affected by the Δflexion angle. CONCLUSIONS: With the CSRP TKA, flexion insertion of the femoral component was associated with postoperative flexion ROM improvement.

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As a powerful paradigm, artificial intelligence (AI) is rapidly impacting every aspect of our day-to-day life and scientific research through interdisciplinary transformations. Living human organoids (LOs) have a great potential for in vitro reshaping many aspects of in vivo true human organs, including organ development, disease occurrence, and drug responses. To date, AI has driven the revolutionary advances of human organoids in life science, precision medicine and pharmaceutical science in an unprecedented way. Herein, we provide a forward-looking review, the frontiers of LOs, covering the engineered construction strategies and multidisciplinary technologies for developing LOs, highlighting the cutting-edge achievements and the prospective applications of AI in LOs, particularly in biological study, disease occurrence, disease diagnosis and prediction and drug screening in preclinical assay. Moreover, we shed light on the new research trends harnessing the power of AI for LO research in the context of multidisciplinary technologies. The aim of this paper is to motivate researchers to explore organ function throughout the human life cycle, narrow the gap between in vitro microphysiological models and the real human body, accurately predict human-related responses to external stimuli (cues and drugs), accelerate the preclinical-to-clinical transformation, and ultimately enhance the health and well-being of patients.

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Objectives: The burden of SARS-CoV-2 infection in people living with HIV (PLHIV) in South Sudan is unknown. Methods: We conducted a cross-sectional seroprevalence survey of SARS-CoV-2 immunoglobulin (Ig) G antibodies and other diseases of public health importance (strongyloidiasis, toxoplasmosis) in PLHIV in South Sudan during April 1, 2020-April 30, 2022. We used a multiplex SARS-CoV-2 immunoassay to detect IgG antibodies targeting the SARS-CoV-2 spike, receptor binding domain, and nucelocapsid (N) proteins, and antigens for other pathogens (Strongyloides stercoralis and Toxoplasma gondii). Results: Among 3518 samples tested, seroprevalence of IgG antibodies to SARS-CoV-2 spike protein and receptor binding domain 591 and nucleocapsid ranged from 1.4% (95% confidence interval [CI]: 0.9-2.1%) in April-June 2020 to 53.3% (95% CI: 49.5-57.1%) in January-March 2022. The prevalence of S. stercoralis IgG ranged between 27.3% (95% CI: 23.4-31.5%) in October-December 2021 and 47.2% (95% CI: 37.8-56.8%) in July-September 2021, and, for T. gondii IgG, prevalence ranged from 15.5% (95% CI: 13.3-17.9%) in April-June 2020 to 36.2% (95% CI: 27.4-46.2%) July-September 2021. Conclusions: By early 2022, PLHIV in South Sudan had high rates of SARS-CoV-2 seropositivity. Surveillance of diseases of global health concern in PLHIV is crucial to estimate population-level exposure and inform public health responses.

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Objectives: To compare the outcomes of modified extended right lobe graft (MERLG) and modified right lobe graft (MRLG) in living-donor liver transplantation (LDLT). Methods: This retrospective study was performed at the Liver transplant department of the Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences Hospital, Gambat, Pakistan, from March 2019 to September 2020. The outcomes of 20 MERLG donors and recipients were compared to those of 74 MRLG donors and recipients. Demographics, operative parameters, complications, hospital stay, and one-year survival were compared between the two groups. Results: The mean graft volume of the MERLG group was more (637.10 ± 71.35 g) than in the MRLG group (562.27 ± 57.77 g), (p= 0.001). Donor blood loss was higher in the MERLG group (680.10±170.60 ml) compared to the MRLG group (650.23±190.65 ml), p=0.527. In addition, the operative time was longer in the MERLG group (345.80±76.90 min) than in the MRLG group (318.12±100.80 min) (p= 0.257). The MERLG recipients were sicker (mean MELD score of 22.54±3.67) than the MRLG (18.86±4.37) (p=0.001). The drain output was higher in the MRLG group (1340 ± 470.32 ml) than in the MERLG group (1110 ± 450.60 ml) (P =0.045). No significant difference was found when comparing postoperative laboratory results and complications between the donor and recipient groups (p >0.05). Kaplan-Meier analysis showed a 95% one-year survival in MERLG group compared to 90.7% in the MRLG group (p=0.549). Conclusion: With appropriate technical expertise, MERLGs are technically safe and feasible in LDLT donors without any added risks. MERLGs also yielded better outcomes in sick recipients.

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Background: Hepatocellular cancer (HCC) is the most common primary liver cancer with increasing incidence. Liver transplantation (LT) has been accepted as main curative liver cancer treatment. The effectiveness of LDLT as opposed to Deceased Donor Liver Transplant (DDLT) for patients with HCC is still controversial. There is limited data comparing the long-term outcomes of patients undergoing LDLT or DDLT for HCCs that do not meet the Milan criteria. Methods: We aimed to compare the perioperative and survival outcomes of LDLT with DDLT in HCC patients.Patients underwent LT between January 2012 and December 2020 were retrospectively analyzed. There were 137 patients who met the UCSF criteria. Of these, 75 patients received LDLT and 62 patients DDLT.The primary end points in the present study were oncologic outcomes such as the recurrence rate, disease-free survival (DFS) and overall survival (OS) of LDLT and DDLT in patients with HCC. Results: PET-CT SUVmax value, the amount of erythrocyte solution (ES) as blood transfusion of red cells given and the tumor recurrence rate were significantly higher among the deceased patients recurrence, ES, PET-CT SUVmax value and tumor differentiation had significant effects on survival. In the multivariate reduced model, cox regression analysis showed significant effects of recurrence, ES, locoregional treatment response and PET-CT on survival.Albeit not significant, the one-year recurrence rate in the LDLT was similar to that in the DDLT, three- and five-year recurrence rates were higher in DDLT compared to LDLT. Conclusion: There is less chance of cold ischemia time and better-quality grafts with minimal fatty changes, lower recurrence rates and similar survival rates can be achieved in LDLT compared to DDLT.

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Purpose: This study aimed to describe adult living donor liver transplantation (LDLT) for acute liver failure and evaluate its clinical significance by comparing its surgical and survival outcomes with those of deceased donor liver transplantation (DDLT). Methods: We retrospectively reviewed the medical records of 267 consecutive patients (161 LDLT recipients and 106 DDLT recipients) aged 18 years or older who underwent liver transplantation between January 2006 and December 2020. Results: The mean periods from hepatic encephalopathy to liver transplantation were 5.85 days and 8.35 days for LDLT and DDLT, respectively (P = 0.091). Among these patients, 121 (45.3%) had grade III or IV hepatic encephalopathy (living, 34.8% vs. deceased, 61.3%; P < 0.001), and 38 (14.2%) had brain edema (living, 16.1% vs. deceased, 11.3%; P = 0.269) before liver transplantation. There were no significant differences in in-hospital mortality (living, 11.8% vs. deceased, 15.1%; P = 0.435), 10-year overall survival (living, 90.8% vs. deceased, 84.0%; P = 0.096), and graft survival (living, 83.5% vs. deceased, 71.3%; P = 0.051). However, postoperatively, the mean intensive care unit stay was shorter in the LDLT group (5.0 days vs. 9.5 days, P < 0.001). In-hospital mortality was associated with vasopressor use (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.45-7.96; P = 0.005) and brain edema (OR, 2.75; 95% CI, 1.16-6.52; P = 0.022) of recipient at the time of transplantation. However, LDLT (OR, 1.26; 95% CI, 0.59-2.66; P = 0.553) was not independently associated with in-hospital mortality. Conclusion: LDLT is feasible for acute liver failure when organs from deceased donors are not available.

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BACKGROUND: The effects of anesthetics on liver and kidney functions after infantile living-related liver transplantation (LRLT) are unclear. This study aimed to investigate the effects of propofol-based total intravenous anesthesia (TIVA) or desflurane-based inhalation anesthesia on postoperative liver and kidney functions in infant recipients after LRLT and to evaluate hepatic ischemia-reperfusion injury (HIRI). METHODS: Seventy-six infants with congenital biliary atresia scheduled for LRLT were randomly divided into two anesthesia maintenance groups: group D with continuous inhalation of desflurane and group P with an infusion of propofol. The primary focus was to assess alterations of liver transaminase and serum creatinine (Scr) levels within the first 7 days after surgery. And the peak aminotransferase level within 72 h post-surgery was used as a surrogate marker for HIRI. RESULTS: There were no differences in preoperative hepatic and renal functions between the two groups. Upon the intensive care unit (ICU) arrival, the levels of aspartate aminotransferase (AST, P = 0.001) and alanine aminotransferase (ALT, P = 0.005) in group P were significantly lower than those in group D. These changes persisted until the fourth and sixth days after surgery. The peak AST and ALT levels within 72 h after surgery were also lower in group P than in group D (856 (552, 1221) vs. 1468 (732, 1969) U/L, P = 0.001 (95% CI: 161-777) and 517 (428, 704) vs. 730 (541, 1100) U/L, P = 0.006, (95% CI: 58-366), respectively). Patients in group P had lower levels of Scr upon the ICU arrival and on the first day after surgery, compared to group D (17.8 (15.2, 22.0) vs. 23.0 (20.8, 30.8) µmol/L, P < 0.001 (95% CI: 3.0-8.7) and 17.1 (14.9, 21.0) vs. 20.5 (16.5, 25.3) µmol/L, P = 0.02 (95% CI: 0.0-5.0) respectively). Moreover, the incidence of severe acute kidney injury was significantly lower in group P compared to that in group D (15.8% vs. 39.5%, P = 0.038). CONCLUSIONS: Propofol-based TIVA might improve liver and kidney functions after LRLT in infants and reduce the incidence of serious complications, which may be related to the reduction of HIRI. However, further biomarkers will be necessary to prove these associations.

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Desflurano , Isoflurano , Riñón , Trasplante de Hígado , Hígado , Propofol , Humanos , Propofol/administración & dosificación , Propofol/efectos adversos , Trasplante de Hígado/efectos adversos , Desflurano/administración & dosificación , Lactante , Masculino , Femenino , Isoflurano/análogos & derivados , Isoflurano/administración & dosificación , Isoflurano/efectos adversos , Riñón/efectos de los fármacos , Hígado/efectos de los fármacos , Anestésicos por Inhalación/administración & dosificación , Anestésicos por Inhalación/efectos adversos , Donadores Vivos , Anestésicos Intravenosos/administración & dosificación , Anestésicos Intravenosos/efectos adversos , Creatinina/sangre , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Pruebas de Función Hepática , Periodo Posoperatorio , Pruebas de Función Renal , Atresia Biliar/cirugía

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Background: Delusions in neurocognitive disorder due to Alzheimer's disease (AD) worsen patients' cognitive functions and activities of daily living (ADL), increasing caregiver burden and the risk of mortality. AD patients with delusions tend to experience a more rapid decline in cognition and have demonstrated poorer performance on various cognitive function tests. Considering the prognosis of delusion in AD patients, it tends to be more favorable with appropriate treatment. However, there is a lack of neuropsychological research, specifically examining the impact of delusions in AD, characterized by progressive deterioration of cognitive function. This study investigates the impact of delusions on cognitive function and ADL under conditions controlling for disease severity. Methods: We compared cognitive function and ADL in AD patients aged 65 years or older according to the presence of delusions. To assess longitudinal change, we analyzed data from patients monitored for an average of 15 to 16 months. We assessed cognitive function and ADL using the Seoul Neuropsychological Screening Battery-Second Edition (SNSB-II) and delusions using the Neuropsychiatric Inventory (NPI). We used IBM SPSS Statistics version 25.0 for all statistical analyses. The analysis was not adjusted for multiple comparisons. We investigated how delusions impact cognitive function and ADL, controlling for age, educational level, and disease severity. Results: The delusions group exhibited poorer immediate recall of verbal memory than the non-delusions group. In the follow-up evaluation, patients who developed delusions had lower baseline cognitive function than those who did not, and their language fluency declined over time. In addition, we found the presence of delusions associated with worse functional impairment in ADL as the disease progressed. Conclusion: While controlling for the severity of AD, we found no significant negative impacts of delusions on most cognitive functions. Nevertheless, it is noteworthy that the immediate recall of verbal memory and the Controlled Oral Word Association Test (COWAT)_animal sensitively detected the negative impact of delusions. Furthermore, since delusions are associated with worsening ADL, we understand that delusion treatment is important for improving the quality of life for patients and caregivers.

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Actividades Cotidianas , Enfermedad de Alzheimer , Deluciones , Pruebas Neuropsicológicas , Humanos , Enfermedad de Alzheimer/psicología , Enfermedad de Alzheimer/complicaciones , Deluciones/etiología , Deluciones/psicología , Actividades Cotidianas/psicología , Femenino , Masculino , Anciano , Anciano de 80 o más Años , Cognición/fisiología , Trastornos Neurocognitivos/etiología , Trastornos Neurocognitivos/psicología , Trastornos Neurocognitivos/diagnóstico , Índice de Severidad de la Enfermedad

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Objective: To evaluate the connection between the items included in the AVD-DezIs score (a questionnaire about basic and instrumental activities of daily living and other topics related to social and personal life) and in-hospital and 30-day mortality after discharge. Methods: Prospective cohort study of hospitalizations in the Internal Medicine ward from 2014 to 2020, including >18 years old patients with a fully completed AVD-DezIs. To identify in-hospital and 30 days mortality, univariate and multivariate logistic models were applied, including random effects if justified. Results: A total of 19,771 episodes of hospitalization were included. In the univariate analysis, except for the presence of isolation and financial insufficiency, all the items were predictors of mortality in-hospital or within 30 days after discharge. In multivariate analysis, older age, male sex, longer hospital stay, higher Charlson score, deficiency in all four activities of daily living, deficiency in meal preparation and housekeeping, presence of pain/depression, immobility, and malnutrition are associated with a higher probability of in-hospital death whereas older age, male gender, higher Charlson score, longer length of hospital stay, deficiency in personal hygiene, ambulation, and eating habits, as well as the presence of incontinence and malnutrition, are associated with a higher probability of 30 days after discharge death. Discussion/Conclusion: Except for isolation and financial insufficiency, all items were individually associated with the outcomes. When they are considered in conjunction and taking into account sex, age, comorbidities and length of stay, the predictive ability of in-hospital and 30 days mortality differed.

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Centers for independent living (CILs) and vocational rehabilitation (VR) agencies offer transition services that many youth with disabilities could benefit from, but little is known about the existence of and potential for collaborations between these agencies. In this study, we examined data from VR agencies to assess their relationships with CILs involving transition-age youth at the national and state levels, focusing on two types of collaborations: referrals from CILs to VR agencies and VR youth's use of CIL services. Although many CILs and VR agencies do work together, their relationships vary, and these collaborations reflect only a small fraction of VR youth who are transition age. Further, for each collaboration type, the VR youth involved in these collaborations differ from other people who apply for or use VR services in terms of their characteristics and service use patterns. The findings point to opportunities for greater collaboration between CILs and VR agencies. They also indicate a need for more research to understand the optimal formats and contexts for such collaborations and the criteria for effectively promoting them at the person and agency levels.

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Background: Both pre-or post-COVID-19, older adults residing in nursing homes are at significant risk for social isolation, which is negatively associated with cognitive ability. Currently, the elderly aged 80 years and older are the fastest-growing age group globally. The extent of social isolation within this group post-COVID-19 and its impact on cognitive abilities remain inadequately explored. Objective: This research aimed to evaluate the prevalence of social isolation among the oldest old in Chinese nursing homes post-COVID-19 and to investigate the mediating and moderating roles of basic activities of daily living (BADL), depression, and subjective socioeconomic status in the relationship between social isolation and cognitive ability. Methods: This cross-sectional study included 453 participants aged 80 years and older from 11 nursing homes in Ningbo, Zhejiang Province, China. Social isolation was assessed using the Lubben Social Network Scale-6 (LSNS-6), cognitive ability using the Mini-Mental State Examination (MMSE), BADL using the Barthel Index (BI), and depression using the Patient Health Questionnaire-9 items (PHQ-9). Mediation and moderation effects were statistically analyzed using SPSS 23.0 and PROCESS 3.5. Results: The mean age of the study sample was 87.1 ± 3.8 years, among whom 60.3% (n = 273) were female, and 56.1% experienced social isolation, with 41.1% and 63.1% being isolated from family and friends, respectively. Social isolation indirectly affected cognitive ability through BADL and depression, respectively, and through the chain mediation effect of BADL and depression. Subjective socioeconomic status moderated the relationships between social isolation and BADL and between social isolation and depression. However, no moderating effect of subjective socioeconomic status was found between social isolation and cognitive ability. Conclusion: This study deepens our understanding of the current state of social isolation and its mechanisms of action in the oldest old post-COVID-19 and provides a new basis for future public health policy development and related research.

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Introduction India has the second-highest number of people living with human immunodeficiency virus (PLHIV). Despite the national decline in the prevalence of the human immunodeficiency virus (HIV) from 2000 to 2021, regional variations persist, particularly in the northeastern and southern states. High-risk populations, including female sex workers (FSW), men who have sex with men (MSM), and injecting drug users (IDU), significantly contribute to these dynamics. This study focuses on high-prevalence districts in Karnataka. Objectives This study aims to identify socioeconomic and behavioral factors associated with high HIV prevalence in high-burden districts of South Indian states. Methodology A cross-sectional study was conducted using data from Integrated Counseling and Testing Centers (ICTCs) and Designated STI/RTI (sexually transmitted infections/reproductive tract infections) Clinics (DSRCs) across 24 centers in the three districts. The centers were determined using a simple random sampling method. Data from 2501 HIV-positive individuals were analyzed, focusing on demographics, risk behaviors, and treatment history. Results Males constituted the majority of HIV cases, accounting for 448 (56.0%) in Vijayapura, 334 (51.4%) in Bagalkot, and 644 (61.1%) in Belagavi districts, with a significant portion referred by government hospitals. High HIV prevalence was linked to adults aged 25-49 years of age; the number of people with HIV was high among daily wage workers and individuals with multiple sexual partners compared to married and educated people. Newly diagnosed discordant couples ranged from 129 (12.2%) in Belagavi to 133 (18.4%) in Vijayapura districts. Most patients were on first-line antiretroviral therapy (ART), with loss to follow-up attributed to system negligence and poor compliance. Conclusion Key determinants of high HIV prevalence include gender, age, marital status, socioeconomic status, and sexual behavior. Effective interventions require targeted education, improved healthcare services, robust surveillance, and strengthened collaboration among stakeholders.

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Functional limitations refer to the dependency to perform activities of daily living. Increasing evidence has demonstrated a bidirectional association between functional limitations and cognitive functioning, although the exact mechanism remains unclear. This study investigated whether social participation bidirectionally mediates the association between functional limitations and cognitive decline. We analyzed a sample of 16,385 middle-aged and older adults (aged over 50 years) using longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS; Waves 1-4). We utilized a cross-lagged panel model to examine the bidirectional mediation of social participation between functional limitations and cognitive functioning over a span of eight years. The results indicated that social participation bidirectionally and partially mediated the relationship between the onset of functional limitations and cognitive decline, indicating that social participation may play an important role in mitigating the disablement process.

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Robotic donor hepatectomy introduces a new era in living donor liver transplantation (LDLT), combining advancements in minimally invasive surgery with superior precision and ergonomics. The beginning of LDLT in 1989 aimed to address the scarcity of deceased donor livers, a situation intensified by the technical and ethical challenges associated with this procedure. The integration of robotic systems since 2010s has broadened the scope and impact of liver transplantation, enhancing outcomes significantly for both donors and recipients. This review discusses the significant advancements in robotic surgery, the ongoing challenges such as cost and training needs, and the future toward global standardization and the integration of artificial intelligence. As this technology continues to evolve, it holds the potential to become the new global standard, ensuring safer procedures and enhanced outcomes for patients worldwide.