Cognitive Frailty and Its Association with Nutrition and Depression in Community-Dwelling Older People.

BACKGROUND: Cognitive frailty is a condition where physical frailty and mild cognitive impairment (MCI) co-exist. It is associated with increased risk of dementia and dependency. Previous studies reported that malnutrition and depression are associated with physical frailty and MCI; however, their relationships with cognitive frailty remained to be explored. The aims of this study were to examine the association of nutrition and depression with cognitive frailty, in comparison to having physical frailty or MCI alone. METHODS: This study employed a cross-sectional design. Data collection was conducted in the community settings on the older people without dementia. Dependent variables were cognitive frailty, physical frailty, and MCI. The independent variables were depression and nutrition. Multi-nominal regression was employed to examine the relationships between the dependent and independent variables. The associations were adjusted by four known co-variates, including age, gender, education and APOE ε4 carrier status. RESULTS: A total of 185 participants were recruited from four community centres and one elderly hostel and completed the data collection. Approximately 44.9% of the older people with physical frailty and 82.5% of elderly with MCI belonged to cognitive frailty. Multi-nominal regression models showed that depression is positively associated with cognitive frailty and with physical frailty, but not associated with solely MCI. Nutrition is negatively associated with cognitive frailty, but not associated with physical frailty or MCI alone. CONCLUSION: Cognitive frailty is associated with malnutrition and depression. Therapeutic interventions managing depression and malnutrition may focus the older people with cognitive frailty to improve efficacy and cost-effectiveness.

Identification of miR-146b-5p in tissues as a novel biomarker for prognosis of gallbladder carcinoma.

OBJECTIVE: Increasing evidence has suggested that dysregulation of microRNAs (miRNAs) could contribute to tumor progression. The aim of present study was to evaluate the feasibility of using miR-146b-5p as a prognostic biomarker in gallbladder cancer (GBC). PATIENTS AND METHODS: We collected 150 pairs of tissue specimens from patients with GBC and adjacent normal specimens. The expression level of miR-146b-5p was measured in 150 GBC tissues and adjacent normal tissues RT-qPCR. Kaplan-Meier method was used to analyze the overall survival. The univariate and multivariable Cox regression analyses were performed to identify whether miR-146b-5p could serve as an independent prognostic factor for GBC patients. RESULTS: miR-146b-5p expression was decreased in GBC tissues compared with that in adjacent normal tissues (p < 0.01). In addition, miR-146b-5p expression was correlated with TNM stage (p = 0.009), liver metastasis (p = 0.001) and differentiated degree (p = 0.022). Kaplan-Meier survival curves showed that GBC patients with high miR-146b-5p expression showed better overall survival than those with low miR-146b-5p expression (p = 0.0005). At last, univariate and multivariate analyses confirmed that increased miR-146b-5p expression was an independent predictive factor of good prognosis for GBC patients. CONCLUSIONS: Our study showed that miR-146b-5p was a potential prognostic biomarker and higher expression of miR-146b-5p is associated with a poor prognosis in GBC.

Prevalence and determinants of positive tuberculin reactions of residents in old age homes in Hong Kong.

OBJECTIVE: To determine the prevalence of tuberculous infection and the predictors of positive tuberculin reactivity in old age home residents in Hong Kong. DESIGN: Cross-sectional study. METHODS: A questionnaire-interview and review of medical records were carried out, together with measurement of weight and height/arm span and assessment of nutritional status. A one-stage tuberculin skin test (TST) was performed using two units of PPD RT23. An induration > or = 10 mm was considered as positive. RESULTS: Of 3682 residents (71.7% participation, mean age 82 years) who agreed to undergo a TST, 46.3% had a positive reaction. Factors associated with a significantly higher risk of a positive TST included being male, an ex- or current smoker and having a past history of tuberculosis (TB). Factors associated with reduced positive tuberculin reactivity included older age groups (> 70 years), a history of cancer and chronic obstructive pulmonary disease and low body mass index quartiles. CONCLUSION: In old age homes, the high prevalence of latent tuberculous infection is responsible for the high rate of active TB due to reactivation. Early diagnosis and treatment are necessary to prevent transmission of disease in these crowded environments with susceptible individuals.

Nuclear ING2 expression is reduced in human cutaneous melanomas.

Cutaneous malignant melanoma is a severe and sometimes life-threatening cancer. The molecular mechanism of melanomagenesis is incompletely understood. Deregulation of apoptosis is probably one of the key factors contributing to the progression of melanoma. The inhibitor of growth (ING) family proteins are candidate tumour suppressors which play important roles in apoptosis. Downregulated expression of ING proteins have been reported in several tumour types, including the loss of nuclear expression of p33ING1b in melanoma. As ING2 exhibits 58.9% homology with p33ING1b, we hypothesized that the aberrant expression of ING2 may be involved in melanomagenesis. Here, we used tissue microarray technology and immunohistochemistry to examine ING2 expression in human nevi and melanoma biopsies. Our data showed that nuclear ING2 expression was significantly reduced in radial growth phase (RGP), vertical growth phase (VGP), and metastatic melanomas compared with dysplastic nevi (P < 0.05). Our data also revealed that nuclear ING2 expression was not associated with patient's gender, age or tumour thickness, ulceration, American Joint Committee on Cancer (AJCC) stage, tumour subtype, location and 5-year survival (P > 0.05). Taken together, our results suggest that nuclear ING2 expression is significantly reduced in human melanomas and that reduced ING2 may be an important molecular event in the initiation of melanoma development.

Unusual cases of human myiasis due to Old World screwworm fly acquired indoors in Hong Kong.

Myiasis is the infestation of tissue by the larvae of flies. We report eight cases of human myiasis in Hong Kong. All patients were nursing home residents with an average age of 81.8 years. Seven patients were bedridden with advanced dementia. Four patients had pre-existing wounds. Five had poor oral hygiene and four of those were on tube feeding. All of the five patients with poor oral hygiene suffered from oral myiasis. Two patients had vaginal infestations and one had wound myiasis in his diabetic foot ulcer. Seven cases were infested by Chrysomya bezziana, an obligatory parasite that requires living mammalian tissue for its larval development. Larvae of the Calliphoridae family were responsible for the remaining case. Patients were managed with manual removal of larvae and irrigation of the site of infestation with saline. All infestations were nosocomial, being acquired in nursing homes. Carers of the old and debilitated should be made aware of the need for better oral care, especially for those on tube feeding. The use of window screens in nursing homes should be encouraged to reduce the chance of flies entering the vicinity of these patients. Electrocuters could also be mounted indoors to kill flies that do enter.

Reduced Apaf-1 expression in human cutaneous melanomas.

Malignant melanoma is a life-threatening skin cancer due to its highly metastatic character and resistance to radio- and chemotherapy. It is believed that the ability to evade apoptosis is the key mechanism for the rapid growth of cancer cells. However, the exact mechanism for failure in the apoptotic pathway in melanoma cells is unclear. p53, the most frequently mutated tumour suppressor gene in human cancers, is a key apoptosis inducer. However, p53 mutation is only found in 15-20% of melanoma biopsies. Recently, it was found that Apaf-1, a downstream target of p53, is inactivated in metastatic melanoma. Specifically, loss of heterozygosity (LOH) of the Apaf-1 gene was found in 40% of metastatic melanoma. To determine if loss of Apaf-1 expression is indeed involved in melanoma progression, we employed the tissue microarray technology and examined Apaf-1 expression in 70 human primary malignant melanoma biopsies by immunohistochemistry. Our data showed that Apaf-1 expression is significantly reduced in melanoma cells compared with normal nevi (chi(2)=6.02, P=0.014). Our results also revealed that loss of Apaf-1 was not associated with the tumour thickness, ulceration or subtype, patient's gender, age and 5-year survival. In addition, our in vitro apoptosis assay revealed that overexpression of Apaf-1 can sensitise melanoma cells to anticancer drug treatment. Taken together, our data indicate that Apaf-1 expression is significantly reduced in human melanoma and that Apaf-1 may serve as a therapeutic target in melanoma.

Predicting stature from knee height in Chinese elderly subjects.

The main aim of this study was to validate the use of the Caucasian-based knee height equations for predicting stature of Chinese elderly subjects and to compare the predicted height to those estimated by equations derived from elderly subjects of Chinese origin. The study was performed by a survey by measurement of convenience samples. Twenty-one women and 26 men were recruited to validate the use of the Caucasian-based equations. The Chinese-based predictive equations were derived from 164 women and 89 men. The sample included ambulatory elderly subjects of Chinese origin, 60 years of age or older. These subjects were without spinal curvature and able to stand erect. Measurements were taken for height by a standard hospital scale. Calipers was used to measure knee height while the subject was in the sitting position. The measured stature and that predicted by the Caucasian-based equations were significantly different in Chinese elderly women but not in men. New regression models are being developed for the elderly Chinese population in Hong Kong. The relationship between stature, knee height and age appears to be ethnicity- and gender-dependent. While stature of elderly Chinese men can be estimated by either the Caucasian-based or Chinese-based equation, the regression model developed in the present study will better estimate the stature in elderly Chinese women.