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Uncovering the added benefits of lowering resting heart rate by physical activity in reducing the incidence and mortality risks of CKD and proteinuria
No full text[[abstract]]Background: Physical activity (PA) is known to be able to reduce Chronic Kidney Disease (CKD) mortality, but the effect was perceived as too little, too late to motivate exercisers. However, smart types of exercise could be employed to double the effect by simultaneously lowering resting heart rate (RHR). The added role of RHR in enlarging the benefits of physical activity to prevent or to reduce CKD has not been reported. Methods: A medical screening cohort of 680,277 adults in Taiwan was successively recruited during 1996-2017, and 64,577 deaths were identified by National Death File and 5,671 cases of ESRD after a medium follow up of 18 years. CKD was analyzed by 5 component stages, eGFR values and proteinuria tested by dipstick. RHR came from electrocardiogram taken after rest in a supine position, with 80-99/min considered as elevated but within normal limits. Physical activity was expressed as MET-h/week, which was a product of exercise intensity and duration. Exercise status was classified as inactive, low, medium high or very high active. The association of RHR with CKD at entry points or with various CKD associated all-cause mortality risks during follow up was both calculated by Cox model. Results: A triangular interactive relationship existed among PA, RHR and CKD, with PA able to reduce both RHR and CKD and with RHR associated with less CKD when slowed down by PA. Increasing RHR per 10 beats from 60/min up was associated with 30% increase in CKD, 39% increase in proteinuria and 30% increase in GFR80%) and could benefit from engaging in all types of PA recommended. When participants exercised, majority (60%) lowered RHR and small minority (9%) increased RHR, with remaining unchanged. Conclusions: The incidence and mortality of CKD and proteinuria could be maximally reduced by vigorous physical activity when RHR was simultaneously lowered. Promoting the kind of exercise that reduced RHR may double the reduction of CKD or proteinuria
Increase in luteinizing hormone is linked to reduction in depression in patients with dementia: Secondary analysis of a randomized clinical trial of benzoate
No full text[[abstract]]LH levels in dementia patients who received sodium benzoate therapy. Moreover, male patients’ LH levels increased after benzoate treatment. Accordingly, in previous studies, low blood levels of LH were related with depressive symptoms in patients with dementia7 and sodium benzoate was able to increase LH concentrations in a male rat study.8 Future studies are warranted to explore the underlying mechanism. In the current study, however, the reduction of depressive symptoms was not significant after 6 weeks of sodium benzoate treatment (with the mean final dose of 622.0 士 340.6 [SD] mg/day),9 as opposed to placebo therapy. In comparison, in a recent dose-comparison study,3 the 24-week, benzoate 1000 mg group performed best in improving cognitive function in dementia patients, followed by the 750 mg group and then the 500 mg group. The study had several limitations. First, the treatment duration was short, and the doses were low. Second, this was a secondary analysis of a previous study.9 Third, this study enrolled dementia patients with behavioral or psychological symptoms (BPSD) rather than with associated depressive symptoms. Fourth, the sample size was limited. Fifth, the study recruited only Han Taiwanese patients. Sixth, we did not measure LH in the CNS. In conclusion, the findings suggest that reduced depression may be related with increased LH after 6 weeks of low-dose benzoate treatment in patients with dementia, and benzoate treatment may increase male patients’ LH levels. To further elucidate the effects of benzoate on depressive symptoms and LH levels, future studies which enroll larger sample sizes of dementia patients with various ethnicities and depressive symptoms to receive longer-duration, optimal-dose benzoate treatment are needed. Plasma levels of LH showed an insignificant trend of increase after 6 weeks of benzoate therapy, when compared to placebo therapy
Workplace violence and mental wellbeing among long-term care nursing assistants in different work locations: A cross-sectional study
No full text[[abstract]]Aims: This study aims to investigate the association between workplace violence and mental wellbeing of long-term care nursing assistants (LTC-NAs) based on work locations. Background: The increasing global elderly population is elevating the demand for LTC services. The LTC-NA population is expanding, highlighting the necessity to create a secure work environment. However, little is known about how workplace violence poses a threat to the mental wellbeing of LTC-NAs across different work locations. Methods: This observational cross-sectional study was conducted from October 2022 to July 2023, involving a survey of 937 certified LTC-NAs recruited through convenience sampling from various Taiwanese LTC units. Participants were evaluated for experiences of four types of workplace violence (physical, psychological, verbal, and sexual harassment) using a disseminated questionnaire. Mental health was assessed using the 5-item Brief Symptom Rating Scale, and client-related burnout was evaluated with the 6-item scale from the Chinese version of Copenhagen Burnout Inventory. Logistic regression identified the association between workplace violence and mental wellbeing. In addition, the relationship among participants working in residential facilities or home settings were examined. Results: The completion rate of the questionnaire was 86%. Psychological violence was associated with poor mental health (adjusted odds ratio [OR] = 2.38 and 95% CI = 1.40-4.05), while verbal violence and sexual harassment were associated with client-related burnout (adjusted OR = 2.03 and 1.75, respectively). All types of workplace violence were more prevalent in residential facilities than home settings; however, the associations of workplace violence with poor mental wellbeing were more prominent among those working in home settings. Among violence victims, a higher proportion of LTC-NAs working in home settings reported experiencing physical and psychological violence from patients' families compared to those working in residential facilities. Client-related burnout was found to mediate the relationship between violence from patients' families and poor mental health. Conclusion: Nonphysical workplace violence and sexual harassment were associated with poor mental wellbeing among LTC-NAs, especially in homecare settings. Violence from patients' families posed a notable risk to homecare LTC-NAs. Therefore, protective policies and organizational training programs should be tailored to address the unique challenges of each work setting
Reclassification of the conventional risk assessment for aging-related diseases by electrocardiogram-enabled biological age
No full text[[abstract]]An artificial intelligence (AI)-enabled electrocardiogram (ECG) model has been developed in a healthy adult population to predict ECG biological age (ECG-BA). This ECG-BA exhibited a robust correlation with chronological age (CA) in healthy adults and additionally significantly enhanced the prediction of aging-related diseases' onset in adults with subclinical diseases. The model showed particularly strong predictive power for cardiovascular and non-cardiovascular diseases such as stroke, coronary artery disease, peripheral arterial occlusive disease, myocardial infarction, Alzheimer's disease, osteoarthritis, and cancers. When combined with CA, ECG-BA improved diagnostic accuracy and risk classification by 21% over using CA alone, notably offering the greatest improvements in cancer prediction. The net reclassification improvement significantly reduced misclassification rates for disease onset predictions. This comprehensive study validates ECG-BA as an effective supplement to CA, advancing the precision of risk assessments for aging-related conditions and suggesting broad implications for enhancing preventive healthcare strategies, potentially leading to better patient outcomes
SGLT-2 inhibitors and the risk of COPD exacerbations and mortality in COPD patients
No full text[[abstract]]RATIONALE: Patients with chronic obstructive pulmonary disease (COPD) are susceptible to acute exacerbations, cardiovascular disease, and premature death. OBJECTIVES: To compare the risk of COPD exacerbation, cardiovascular diseases, and mortality between sodium-glucose cotransporter-2 (SGLT-2) inhibitor use and no use in patients with type 2 diabetes mellitus (T2DM) and COPD. METHODS: The study included 299,168 patients diagnosed with T2DM and COPD in the National Health Insurance Research Database from January 1, 2009, to December 31, 2020. Cox proportional hazards models were used to examine the relative hazard of major adverse cardiovascular events, hospitalization for COPD, noninvasive positive pressure ventilation (NIPPV), invasive mechanical ventilation, lung cancer, and mortality between SGLT-2 inhibitor users and nonusers. We used propensity score matching to select 1288 pairs of SGLT-2 inhibitor users and nonusers. MEASUREMENTS AND MAIN RESULTS: In the matched cohorts, SGLT-2 inhibitor use was associated with a significantly lower risk of mortality (aHR 0.64, 95% CI 0.43-0.95), NIPPV (aHR 0.48, 95% CI 0.27-0.87), and hospitalization for COPD (aHR 0.82, 95% CI 0.69-0.98) than SGLT-2 inhibitor non-use. Subgroup and dose-response analyses showed that SGLT-2 inhibitor use was associated with a significantly lower risk of mortality, NIPPV, and hospitalization for COPD (p<0.05) than no use of SGLT-2 inhibitors. CONCLUSIONS: This population-based cohort study showed that SGLT-2 inhibitors use was associated with a lower risk of COPD exacerbations, ventilator support, and mortality than non- SGLT-2 inhibitors use in patients with T2DM and COPD. SGLT-2 inhibitors may have a role in treating patients with COPD and diabetes
MetS-Z: A gender- and age-specific scoring system for predicting type 2 diabetes
No full text[[abstract]]AIMS: Current metabolic syndrome (mets) criteria often lack consideration for age and gender differences. This study introduces the mets-Z score, a novel tool designed to enhance mets assessment and improve long-term outcome predictions. MATERIALS AND METHODS: The mets-Z score was developed using principal component analysis (PCA) to weight five mets indicators-waist circumference, blood glucose, blood pressure, high-density lipoprotein (HDL) cholesterol, and triglycerides-by gender and age. Data from 188,739 Taiwan Biobank participants, stratified by gender and age groups (20-39, 40-54, 55-64, 65+ years), were analyzed. Predictive performance for type 2 diabetes mellitus onset was assessed over a 4- to 5-year follow-up. RESULTS: The mets-Z score achieved superior accuracy in predicting type 2 diabetes mellitus onset, with an AUC of 0.76 in men and 0.80 in women, significantly outperforming conventional indices (P < 0.0001). CONCLUSIONS: By integrating age- and gender-specific variations, the mets-Z score provides a more personalized and precise tool for assessing metabolic and diabetes risk, surpassing existing methods. The tool is available for public use at http://bioinfolab.nhri.edu.tw/metsz/, supporting broader applications in precision medicine
Use of artificial intelligence, internet of things, and edge intelligence in long-term care for older people: Comprehensive analysis through bibliometric, Google trends, and content analysis
No full text[[abstract]]BACKGROUND: The global aging population poses critical challenges for long-term care (LTC), including workforce shortages, escalating health care costs, and increasing demand for high-quality care. Integrating artificial intelligence (AI), the Internet of Things (IoT), and edge intelligence (EI) offers transformative potential to enhance care quality, improve safety, and streamline operations. However, existing research lacks a comprehensive analysis that synthesizes academic trends, public interest, and deeper insights regarding these technologies. OBJECTIVE: This study aims to provide a holistic overview of AI, IoT, and EI applications in LTC for older adults through a comprehensive bibliometric analysis, public interest insights from Google Trends, and content analysis of the top-cited research papers. METHODS: Bibliometric analysis was conducted using data from Web of Science, PubMed, and Scopus to identify key themes and trends in the field, while Google Trends was used to assess public interest. A content analysis of the top 1% of most-cited papers provided deeper insights into practical applications. RESULTS: A total of 6378 papers published between 2014 and 2023 were analyzed. The bibliometric analysis revealed that the United States, China, and Canada are leading contributors, with strong thematic overlaps in areas such as dementia care, machine learning, and wearable health monitoring technologies. High correlations were found between academic and public interest, in key topics such as "long-term care" (τ=0.89, P<.001) and "caregiver" (τ=0.72, P=.004). The content analysis demonstrated that social robots, particularly PARO, significantly improved mood and reduced agitation in patients with dementia. However, limitations, including small sample sizes, short study durations, and a narrow focus on dementia care, were noted. CONCLUSIONS: AI, IoT, and EI collectively form a powerful ecosystem in LTC settings, addressing different aspects of care for older adults. Our study suggests that increased international collaboration and the integration of emerging themes such as "rehabilitation," "stroke," and "mHealth" are necessary to meet the evolving care needs of this population. Additionally, incorporating high-interest keywords such as "machine learning," "smart home," and "caregiver" can enhance discoverability and relevance for both academic and public audiences. Future research should focus on expanding sample sizes, conducting long-term multicenter trials, and exploring broader health conditions beyond dementia, such as frailty and depression
TCOG T5221 trial: A phase II randomized study of gemcitabine and nab-paclitaxel in combination with S-1/LV (GASL) or oxaliplatin (GAP) as first-line treatment for metastatic pancreatic cancer
No full text[[abstract]]Background: Gemcitabine plus nab-paclitaxel (GnP), given weekly for consecutive 3 weeks every 4 weeks, is one of the standard treatment for metastatic pancreatic adenocarcinoma (mPDAC); however, the objective response rate (ORR) is only 23% and the standard GnP is too toxic for Asian (71% grade 3–4 neutropenia in the Japanese study). Prior study showed biweekly GnP could reduce toxicities, which provided the opportunity to add other agents to overcome tumor heterogeneity. This study aims to assess the efficacy and safety of biweekly GnP plus either S-1/LV (GASL) or oxaliplatin (GAP). Methods: The major inclusion criteria were histologically confirmed mPDAC with adequate organ functions. The primary endpoint was ORR. Utilizing a 'pick the winner' approach, a parallel Simon two-stage design was employed to test if ORR could achieve 41% in either arm. The study arm would proceed to the second stage if there were 6 or more responders among the first 24 patients in each arm. Both arm consisted of nab-paclitaxel 125 mg/m2, gemcitabine 800 mg/m2 on day 1 in a 2-week cycle while GASL arm adding oral S-1 60-100 mg per day and leucovorin 30 mg BID on day 1-7 and GAP adding oxaliplatin 75 mg/m2 on day 1. Results: Between January and December 2022, the initial 50 patients were randomly assigned to GASL (n=27) and GAP (n=23). At the interim analysis, due to futility, GAP arm was closed in the first stage. Subsequently, all patients were assigned to the GASL arm to a final number of 43. The GASL arm met its primary endpoint, with an ORR of 53.5%, while the ORR of the GAP arm was 17.4%. The median duration of follow-up was 17.7 months (95% CI, 12.0-18.0). The median progression-free survival was 8.6 months (95% CI, 7.4-not reached) in the GASL arm and 5.4 months (95% CI, 3.0-9.0) in the GAP arm. The corresponding median overall survival was 14.6 months (95% CI, 7.0 – not reached) and 7.7 months (95% CI, 5.6-11.7). The most common grade 3-4 adverse events were neutropenia and anemia (up to 14%) in both arm. Conclusions: GASL demonstrated high ORR with promising survival and relatively low toxicity and could be considered as an alternative first-line regimen in Asian mPDAC
Mortality risks of cardiovascular-kidney-metabolic syndrome components based on a large Asian cohort of more than a half million participants
No full text[[abstract]]Background: The American Heart Association (AHA) has recently issued guidelines addressing the “Cardiovascular-Kidney-Metabolic (CKM) Syndrome” to mitigate cardiovascular diseases. This interdisciplinary concept of health medicine emphasizes the impact of multiple disease interactions rather than individual disease factors. This study aims to evaluate CKM prevalence and its associated components mortality risks in a substantial Asian cohort. Methods: The investigation focused on a cohort of 515,602 participants aged 20 years and above enrolled in a health screening program in Taiwan spanning from 1996 to 2017. The study assessed all-cause, cardiovascular disease (CVD) and cause-specific mortality related to CKM stages and its components—hypertension, diabetes, chronic kidney disease, metabolic syndrome, and hyperlipidemia. Multivariate Cox proportional hazards models were employed to calculate hazard ratios (HRs). We use Chiang's life table method to present the years of life lost for each CKM components. Results: Among this cohort, 67.2% had CKM, with prevalence rates of 25.3%, 34.6%, 4.8%, and 2.5% in Stages 1, 2, 3, and 4, respectively. Among those aged 60 and above, nearly 90% had CKM. CKM was associated with a higher risk of all-cause mortality (HR: 1.37, 95% CI: 1.31-1.43), and CVD mortality (HR: 2.12, 95% CI: 1.89-2.39). Each additional component of CKM was associated with a 23% increase in the risk of death (HR: 1.23, 95% CI: 1.22-1.24) and a 38% increase in the risk of CVD mortality (HR: 1.38, 95% CI: 1.36-1.40) compared to participants without any CKM components. With each additional component, the average life expectancy decreases by 3 years. Conclusion: The prevalence rates of CKM and its components vary, contributing to distinct risks of mortality. A clustering phenomenon exists among different components, where an increased number of components corresponds to a higher risk of all-cause, CVD mortality and end-stage kidney disease incidence
Interleukin 26 attenuates osteoblast differentiation in osteoarthritis patients by activating COX2 and NF-κB pathways
No full text[[abstract]]Aims: Osteoarthritis (OA) represents the prevailing form of degenerative joint pathology. Recent investigations have revealed a heightened expression of interleukin 26 (IL-26) in various inflammatory arthritic conditions, including OA. However, the specific impacts and functions of IL-26 on osteoblasts (OBs) within the context of OA remain inadequately elucidated. This study aims to clarify the effects and underlying mechanisms of IL-26 by examining its influence on osteoblasts isolated from OA patients and a murine osteoblast cell line. Methods: Human primary osteoblasts and mouse pre-osteoblast cells were subjected to treatment with beta-glycerophosphate or concurrent treatment with IL-26 to observe the effects on osteoblast differentiation. The differentiation of osteoblasts was assessed through the expression of relevant genes using reverse transcription-polymerase chain reaction (RT-PCR). Key molecular mechanisms of downstream signaling pathways were examined through immunoblotting assays. Results: Our results reveal that IL-26 mitigates osteoblast differentiation and reduces the expression of the marker alkaline phosphatase. Furthermore, the NF-kappa B downstream OB proliferated marker iNOS and inhibition OB differentiated marker LCN2 messenger RNA are up-regulated in IL-26 treated group. Also, phosphorylation and nuclear translocation of NF-kappa B p65 occur following IL-26 stimulation. Additionally, IL-26 enhances the downstream transcription factor cyclooxygenase-2 (COX2), a major player associated with iNOS. STAT1, the canonical receptor signaling pathway of IL-26 is activated. Conclusion: In summary, our findings substantiate the role of IL-26 in osteoarthritis and identify it as a potential therapeutic target for intervention in osteoarthritic pathology