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Philip Eng,1 Lean Huat Lim,2 Chian Min Loo,3 James Alvin Low,4 Carol Tan,5 Eng Kiat Tan,6 Sin Yew Wong,7 Sajita Setia8 1Philip Eng Respiratory and Medical Clinic, Mount Elizabeth Medical Center, 2Dr Lim Lean Huat and Associates Pte Ltd, 3Department of Respiratory and Critical Care Medicine, Singapore General Hospital, 4Department of Geriatric Medicine, Khoo Teck Puat Hospital, 5Rophi Clinic, Mount Elizabeth Novena Specialist Centre, Singapore, 6Kevin Tan Clinic for Diabetes, Thyroid, and Hormones, Mount Elizabeth Medical Center, 7Infectious Disease Partners Pte Ltd, Gleneagles Medical Center, 8Medical Affairs Department, Pfizer Pte Ltd, SingaporeAbstract: The burden of disease associated with Streptococcus pneumoniae infection in adults can be considerable but is largely preventable through routine vaccination. Although substantial progress has been made with the recent licensure of the new vaccines for prevention of pneumonia in adults, vaccine uptake rates need to be improved significantly to tackle adult pneumococcal disease effectively. Increased education regarding pneumococcal disease and improved vaccine availability may contribute to a reduction in pneumococcal disease through increased vaccination rates. The increase in the elderly population in Singapore as well as globally makes intervention in reducing pneumococcal disease an important priority. Globally, all adult vaccines remain underused and family physicians give little priority to pneumococcal vaccination for adults in daily practice. Family physicians are specialists in preventive care and can be leaders in ensuring that adult patients get the full benefit of protection against vaccine-preventable diseases. They can play a key role in the immunization delivery of new and routine vaccines by educating the public on the risks and benefits associated with vaccines. Local recommendations by advisory groups on vaccination in adults will also help to tackle vaccine preventable diseases in adults.Keywords: pneumococcal vaccine, pneumonia, invasive pneumococcal disease, adults

Jonathan WH Wong,1 Margaret Ip,2 Arthur Tang,3 Vivian WI Wei,1 Samuel YS Wong,1 Steven Riley,4 Jonathan M Read,5,6,* Kin On Kwok1,7,8,* 1Faculty of Medicine, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; 2Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; 3Department of Software, Sungkyunkwan University, Seoul, South Korea; 4MRC Centre for Outbreak Analysis and Modelling, Department for Infectious Disease Epidemiology, Imperial College London, UK; 5Centre for Health Informatics Computing and Statistics, Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK; 6Institute of Infection and Global Health, The Farr Institute@HeRC, University of Liverpool, Liverpool, UK; 7Faculty of Medicine, Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, Hong Kong Special Administrative Region, China; 8Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China *These authors contributed equally to this work Objective: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging global public health threat. In response to a highlighted strategic priority of the World Health Organization Global Action Plan on Antimicrobial Resistance, to “strengthen the knowledge and evidence base through surveillance and research”, we synthesized published articles to estimate CA-MRSA carriage prevalence in the Asia-Pacific region. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO CRD:42017067399). We searched MEDLINE, EMBASE, and PubMed for articles published from 1 January 2000 to 19 May 2017, which reported CA-MRSA carriage (defined as either colonization or infection) in Asia-Pacific region from 2000 to 2016. Studies were stratified according to settings (community or hospital where CA-MRSA was isolated) and study populations (general public or subpopulations with specified characteristics). Ranges of CA-MRSA carriage prevalence were reported for study groups. Results: In total, 152 studies were identified. Large diversity was observed among studies in most study groups. In community-level studies, the CA-MRSA carriage prevalence among the general public ranged from 0% to 23.5%, whereas that ranged from 0.7% to 10.4% in hospital settings. From community-level studies, countries with the highest prevalence were India (16.5%–23.5%), followed by Vietnam (7.9%) and Taiwan (3.5%–3.8%). Children aged ≤6 (range: 0.5%–40.3%) and household members of CA-MRSA carriers (range: 13.0%–26.4%) are subgroups without specific health conditions but with much higher CA-MRSA carriage when compared to the general population. Conclusion: Our CA-MRSA prevalence estimates serve as the baseline for future national and international surveillance. The ranges of prevalence and characteristics associated with CA-MRSA carriage can inform health authorities to formulate infection control policies for high-risk subgroups. Future studies should explore the heterogeneities in CA-MRSA carriage prevalence among subgroups and countries to clarify the predominant transmission mechanisms in Asia-Pacific and other regions. Keywords: antimicrobial resistance, emerging global health threat, population studies, methicillin-resistant Staphylococcus aureus

Objectives: Recent evidence suggests that depression can result in abdominal obesity in the elderly. Few longitudinal studies are available and none has been conducted outside the United States.Methods: To examine the relationship between depressive symptoms and abdominal obesity, data from 3,998 community-dwelling Chinese elderly men and women age 65 years and older with 4-year follow-up were analyzed. Depression was defined by a Geriatric Depression Scale score of 8 or higher. At baseline and after 4 years, overall obesity measures included body mass index, percentage of body fat, and general adiposity or body fat index (expressed by total body fat mass measured by DEXA (dual-energy x-ray absorptiometry) in kilograms divided by the square of stature in meters). Abdominal obesity measures included waist circumference, waist to hip ratio, and relative truncal fat (ratio of truncal fat mass to total fat mass measured by DEXA).Results: After adjustment for sociodemographics, lifestyle, and medical factors, the presence of clinically relevant depressive symptoms at baseline was associated with significant decrease in waist circumference at follow-up after adjusting for sociodemographic factors, baseline obesity, lifestyle, and medical factors (β = -1.801, t = -2.93, df = 1564, p = 0.0034), although this relationship disappeared in older age women in further age-stratified analysis.Conclusions: This study shows that depressive symptoms may result in a decrease in abdominal obesity, suggesting that more research is needed to further explore this relationship. Similar studies conducted in different cultural groups may help to explain these conflicting findings. [ABSTRACT FROM AUTHOR]

Abstract: Background: Identification of depression as an independent factor for increased hospital service utilization, or as part of other factors, is important for primary healthcare in possibly preventing use of hospitals. The objective of this study was to study the effects of having clinically relevant depressive symptoms in community dwelling elderly on all cause hospitalization in the elderly. Methods: We administered the validated Chinese version of Geriatric Depression Scale on 3770 men and women aged 65years and over. Duration and episodes of hospitalization were assessed using 4-monthly telephone interviews and database from the Hospital Authority over a 4-year period. The associations between the presence of clinically relevant depressive symptoms and the number of hospitalizations and duration of hospitalization were studied by multiple Poisson regression analysis. Results: The presence of clinically relevant depressive symptoms was independently associated with increased episodes (RR: 1.29; CI: 1.16–1.43) and increased length of stay (RR: 1.18; CI: 1.10–1.25) for all cause hospitalization in those with and without chronic conditions at baseline. Limitation: Our study relied on self report of chronic medical conditions. As a result, under-diagnosis of diseases and misclassification of disease status could not be excluded. Conclusion: It was shown that clinically relevant depressive symptoms are independently associated with inpatient utilization over a 4-year period after adjustment for socioeconomic and health status in these elderly subjects. Identification and effective management of depression in primary care may be one way to reduce hospital service utilization in the elderly in China. [Copyright &y& Elsevier]

BACKGROUND: With the rapid growth of the older population, early detection of cognitive deficits is crucial in slowing down functional deterioration of the elderly persons. OBJECTIVES: To examine the validity and reliability of the Chinese (Cantonese) version of the Hierarchic Dementia Scale (CV-HDS) for Chinese older persons in Hong Kong. METHODS: The HDS was translated into Cantonese Chinese. The content and cultural validity were evaluated by six expert panel members. Sixty-two participants with diagnosis of dementia were recruited for evaluation. Inter-rater reliability, test-retest reliability, internal consistency and concurrent validity were examined. RESULTS: The CV-HDS demonstrated satisfactory psychometric properties. inter-rater reliability and test-retest reliability were high (alpha = 0.89 and alpha = 0.94 respectively). High value of Cronbach's alpha (alpha = 0.94) demonstrated good internal consistency. The concurrent validity of CV-HDS, through correlation with its scores with that of the Chinese version of Mini Mental Status Examination, was established (ranged from r = 0.58 to r = 0.78, p < 0.01). CONCLUSIONS: The CV-HDS is a reliable and valid instrument for assessing severity of cognitive impairment in Cantonese speaking Chinese people with dementia. It facilitates treatment planning to optimize the effects of functional training and rehabilitation. Copyright (c) 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Economic and social factors are determinants of health, as are psychosocial factors. The present study compared self-perceived social status and its relation to health, health related quality of life and lifestyle in older women with men, adjusting for age, education level and maximum lifetime income. A cross-sectional study was conducted of 4,000 men and women aged 65 years and over in a community in the North Eastern part of Hong Kong, a Special Administrative Region in China. Participants were asked to rate their community status, education, income and occupation, on two ladders, each with ten rungs. The distributions of the two ladder scores differed, showing that although participants may not have been ranked highly in terms of money, education and job respectability, they may have ranked their community standing highly. Women and older participants tended to rank their community standing highly in spite of lower ratings in the objective measures. A social gradient in self-perceived social status, independent of objective socioeconomic measures, was noted for physical performance and health-related quality of life, rather than related to presence of specific chronic diseases or lifestyle. However, the different ratings of the two ladders suggested that mechanisms by which the gradient operates may differ between women and men. Further studies are needed to explore the health and psychosocial consequences of the gender difference in self-rated social status. [ABSTRACT FROM AUTHOR]

The growth and development of children with developmental disability depend very much on the parents.The present study was designed to examine whether family-focused education could enhance parental skills, knowledge and competency.The enhancement would in turn result in greater parental participation in the rehabilitation process of these children.The parental needs of Chinese parents were reviewed for the formulation of the Family-Focused Education Programme, which was then implemented, and evaluated using a pre-test/post-test control group design. Forty parents were invited to participate in the study using a convenience sampling technique.The mean scores of these variables were in the direction of increasing after the programme, though repeated measures ANOVA did not indicate any statistically significant changes in parenting knowledge, attitude and stress. It was apparent that the Family-Focused Education Programme enhanced parental competence. Undoubtedly, the family-focused approach is crucial for enhancing parenting competency, and education is fundamental to enabling parents. [ABSTRACT FROM AUTHOR]

To determine the feasibility of increasing the calcium, protein and calorie intake of osteoporotic fracture patients by repeated dietary counselling delivered by a dietitian, a randomized controlled trial was conducted. Among 189 patients presenting with osteoporotic fractures to an Orthopaedics and Traumatology Department of a large regional hospital, 98 patients were randomized to the intervention group and 91 were randomized to the control group (with usual care). Intervention group received three sessions of dietary counselling with tailored made recommendations over a period of 4 months, while the control group only received dietary assessment and pamphlets on the prevention of osteoporosis. Almost all subjects in both intervention and control groups had calcium intake below the recommended level of 1000 mg at baseline. Half and 60% of subjects in both groups had total energy and protein intake below recommended levels respectively. The mean weights of control and intervention groups at baseline were 51.5 and 50.9 kg respectively, while the body mass index (BMI) were 22.6 (kg m(-2)) and 22.6 (kg m(-2)) respectively. After dietary intervention, significant increase of intake was seen in calcium intake (P = 0.0095 by t-test) in the intervention group. No significant increase was seen in protein or calorie intake. No significant change was observed in the body weight or BMI although there was a positive trend in the intervention group for all these parameters. We concluded that there was general malnutrition in Chinese elderly who presented with osteoporotic fractures. Dietary calcium could be increased by repeated professional dietary counselling. Future studies with longer duration and more objective clinical outcomes will be helpful to further demonstrate the long-term effects of dietary intervention on osteoporosis and other chronic diseases. [ABSTRACT FROM AUTHOR]

Recently, more attentions have been paid to natural polymer-based flocculants in wastewater treatment, since they are believed to be low-cost, nontoxic, and environmentally friendly materials. In present work, a hybrid flocculant namely magnetic cellulose (Magcell) was successfully synthesised through simple crosslinking method. As preliminary study, effect of ratio between magnetite powder and cellulose and also volume of glutaraldehyde as crosslinking agent were selected in this research. Meanwhile, the effectiveness of flocculant was determined by performing a jar test to treat an anaerobically treated palm oil mill effluent (AnPOME). The best ratio cellulose to magnetite powder and volume of closslinker was chose based on optimum removal of turbidity, total suspended solid (TSS), colour and chemical oxygen demand (COD) from sample wastewater. Result shows that the best combination cellulose to magnetite powder are 1 : 1 (g/g) with glutaraldehyde volume of 1.5 mL. This optimum parameters show about 74.60 %, 63.90 %, 77.20 %, and 55.80 % reduction in turbidity, colour, TSS, and COD. Overall, approach to produce magnetic cellulose as newly hybrid flocculant has potential to substitute existence flocculants due to the better performance.

MicroRNAs (miRNAs) comprise a group of small non-coding RNA –21 nucleotides in length. They act as post-transcriptional regulators of gene expression by forming base pairing interactions with target messenger RNA (mRNA). At least 1000 miRNAs are predicted to be expressed in humans and are encoded for in the genome of almost all organisms. Functional studies indicate that every cellular process studied thus far is regulated at some level by miRNAs. Given this expansive role, it is not surprising that disruption of this crucial pathway underlies the initiation of, or in the least, contributes to the development and progression of numerous human diseases and physiological disorders. This review will focus on the latest developments in uncovering the mechanism(s) of miRNA-mediated silencing with specific reference to the function of terminal effector proteins, how translation of target mRNA is inhibited and whether we are moving towards understanding this fundamental gene silencing paradigm.

Since the foundation of the Chinese People's Republic, in the course of over 60 years - from 1949 to 2011, substantial transformations have occurred in the social structure of Chinese society. Rapid economic, political and cultural development of China has resulted in deep social transformations. The article reveals the logic, reasons and consequences of these transformations; the author identifies the qualitative and quantitative features of the structure of Chinese society in a wide historical perspective of half a century.

Background: Measure Yourself Medical Outcome Profile (MYMOP) is a patient generated outcome instrument applicable in the evaluation of both allopathic and complementary medicine treatment. This study aims to adapt MYMOP into Chinese, and to assess its validity, responsiveness and minimally important change values in a sample of patients using Chinese medicine (CM) services.Methods: A Chinese version of MYMOP (CMYMOP) is developed by forward-backward-forward translation strategy, expert panel assessment and pilot testing amongst patients. 272 patients aged 18 or above with subjective symptoms in the past 2 weeks were recruited at a CM clinic, and were invited to complete a set of questionnaire containing CMYMOP and SF-36. Follow ups were performed at 2nd and 4th week after consultation, using the same set of questionnaire plus a global rating of change question. Criterion validity of CMYMOP was assessed by its correlation with SF-36 at baseline, and responsiveness was evaluated by calculating the Cohen effect size (ES) of change at two follow ups. Minimally important difference (MID) values were estimated via anchor based method, while minimally detectable difference (MDC) figures were calculated by distribution based method.Results: Criterion validity of CMYMOP was demonstrated by negative correlation between CMYMOP Profile scores and all SF-36 domain and summary scores at baseline. For responsiveness between baseline and 4th week follow up, ES of CMYMOP Symptom 1, Activity and Profile reached the moderate change threshold (ES>0.5), while Symptom 2 and Wellbeing reached the weak change threshold (ES>0.2). None of the SF-36 scores reached the moderate change threshold, implying CMYMOP's stronger responsiveness in CM setting. At 2nd week follow up, MID values for Symptom 1, Symptom 2, Wellbeing and Profile items were 0.894, 0.580, 0.263 and 0.516 respectively. For Activity item, MDC figure of 0.808 was adopted to estimate MID.Conclusions: The findings support the validity and responsiveness of CMYMOP for capturing patient centred clinical changes within 2 weeks in a CM clinical setting. Further researches are warranted (1) to estimate Activity item MID, (2) to assess the test-retest reliability of CMYMOP, and (3) to perform further MID evaluation using multiple, item specific anchor questions. [ABSTRACT FROM AUTHOR]

Despite the growing recognition of the impact of urban environments on social health, limited research explores the combined associations of multiple urban exposures, particularly in dense cities. This study examines the interplay between greenspace, air pollution, and social health as well as the underlying pathways and population heterogeneity in Hong Kong using cross-sectional survey data from 1977 adults and residential environmental data. Social health includes social contacts, relations, and support. Greenspace used street-view greenness (SVG), park density, and the normalized difference vegetation index (NDVI). 100-m daily ground NO 2 and O 3 , indicative of air pollution, were derived using a spatiotemporal deep learning model. Mediators involved physical activity and negative emotions. Main analyses were performed in a 1000-m buffer with multivariate logistical regressions, stratification, interaction, and Partial Lease Square - Structural Equation Modelling (PLS-SEM). Multi-exposure models revealed positive associations between park density/SVG and social contacts, as well as between SVG and social relations, while O 3 was negatively associated with social relations/support. Significant moderators included age, birthplace, employment, and education. PLS-SEM indicated direct positive associations between SVG and social contacts/relations and significant indirect negative associations between NO 2 /O 3 and social health via negative emotions. This study adds to urban health research by exploring complex relationships between greenspace, air pollution, and social health, highlighting the role of the environment in fostering social restoration., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Nonhealing perineal wounds have been reported to be common after proctectomy for Crohn's disease (CD). We performed a systematic review and meta-analysis of perineal wound healing after proctectomy for CD and assessed the risk factors for nonhealing., Methods: A comprehensive literature search was conducted in PubMed, Embase, and Scopus databases from 2010 to 2023, and articles reporting perineal wound healing rates after proctectomy for CD were included. Data on study characteristics and proportion of healed wounds, and risk factors, were extracted. Random-effects meta-analysis was performed to estimate the pooled proportion and 95% CIs using the "meta" package in R. Heterogeneity was assessed using the I2 statistic., Results: We identified 501 articles, of which 252 remained after de-duplication. After screening, 4 retrospective cohort studies involving 333 patients were included. Across the 4 studies, the pooled proportion of completely healed perineal wounds at 6 months was 65% (95% CI 52%-80%), and 70% (95% CI 60%-83%) at 12 months. Significant heterogeneity was found between studies (I2 = 86% at 6 months). Three studies examined risk factors for impaired healing after proctectomy. One study identified preoperative perineal sepsis as the only independent factor associated with impaired healing (P = .001) on multivariable analysis. In 1 study, male sex, shorter time from diversion to proctectomy, and higher preoperative C-reactive protein levels were all associated with delayed healing in univariate analysis. Another study found that close rectal dissection was associated with significantly lower healing rates than total mesorectal excision (P = .01). Prior use of tumor necrosis factor inhibitors was not associated with wound healing outcomes., Conclusions: This meta-analysis revealed complete perineal healing in only 70% of patients 12 months after proctectomy for CD. This highlights knowledge gaps, including the identification of modifiable risk factors and methods for preventing or as rescue therapy, such as vacuum-assisted closure and flap reconstruction, for nonhealing perineal wounds after proctectomy for CD. Poor perineal wound healing outcomes are likely related to imperfectly understood underlying inflammatory dysregulation and systemically impaired wound healing in patients with CD., (© The Author(s) 2024. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Although the general seroprevalence of hepatitis C virus (HCV) infection in Hong Kong is <0.5 %, Hong Kong is still striving for HCV elimination owing to barriers in care cascade encompassing linkage-to-care (LTC), treatment initiation and adherence. We aimed to evaluate the feasibility of a pilot model of micro-elimination to strengthen the HCV care cascade for high-risk groups in Hong Kong., Methods: We initiated the pilot Conquering Hepatitis vIa Micro-Elimination (CHIME) program which adopts an integrated care approach involving outreach visits to halfway house or drug rehabilitation centers run by non-governmental organizations. Participants with history of injection drug use (PWID), recreational drug use, or imprisonment were included. We performed point-of-care test for anti-HCV with reflex HCV RNA testing. LTC with government-subsidized direct acting antiviral was provided to viremic participants. We compared the impact on the care cascade with a cohort of HCV patients (17.8 % PWID) under usual care., Results: 396 participants (62.9 % PWID) were screened and 187 (47.2 %) were viremic, of which 29.8 % had cirrhosis. Proportion with LTC, treatment initiation and adherence were 76.5 % and 63.7 %, 90.9 % and 85.8 %, and 90.0 % and 92.2 %, for the CHIME program and usual care, respectively. The CHIME program was significantly associated with higher odds of LTC (OR 1.797, 95 % CI 1.221-2.644). Non-engagement in care (affecting 37.9 % participants with HCV viremia) was associated with unemployment (OR 2.165, 95 % CI 1.118-4.190)., Conclusion: The pilot CHIME program demonstrated feasibility of an integrated approach to consolidate the HCV care cascade in high-risk populations in Hong Kong., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: LY Mak is an advisory board member of Gilead Sciences and received speaker's fees from AbbVie. WK Seto received speaker's fees from AstraZeneca, is an advisory board member and received speaker's fees from Abbott, received research funding from Alexion Pharmaceuticals, Boehringer Ingelheim, Pfizer and Ribo Life Science, and is an advisory board member, received speaker's fees and researching funding from Gilead Sciences. MFY is an advisor/consultant for and/or received grant/research support from AbbVie, Aligos Therapeutics, AiCuris, Antios Therapeutics, Arbutus Biopharma, Arrowhead Pharmaceuticals, Assembly Biosciences, Bristol-Myers Squibb, Clear B Therapeutics, Dicerna Pharmaceuticals, Finch Therapeutics, Fujirebio Incorporation, GlaxoSmithKline, Gilead Sciences, Immunocore, Janssen, Roche, Silverback Therapeutics, Sysmex Corporation, Tune Therapeutics, Vir Biotechnology and Visirna Therapeutics. The other authors have nothing to disclose., (Copyright © 2024 Elsevier B.V. All rights reserved.)

This study explores the impact of thermal motion on the magnetic compass mechanism in migratory birds, focusing on the radical pair mechanism within cryptochrome photoreceptors. The coherence of radical pairs, crucial for magnetic field inference, is curbed by spin relaxation induced by intra-protein motion. Molecular dynamics simulations, density-functional-theory-based calculations, and spin dynamics calculations were employed, utilizing Bloch-Redfield-Wangsness (BRW) relaxation theory, to investigate compass sensitivity. Previous research hypothesized that European robin's cryptochrome 4a (ErCry4a) optimized intra-protein motion to minimize spin relaxation, enhancing magnetic sensing compared to the plant Arabidopsis thaliana's cryptochrome 1 (AtCry1). Different correlation times of the nuclear hyperfine coupling constants in AtCry1 and ErCry4a were indeed found, leading to distinct radical pair recombination yields in the two species, with ErCry4a showing optimized sensitivity. However, this optimization is likely negligible in realistic spin systems with numerous nuclear spins. Beyond insights in magnetic sensing, the study presents a detailed method employing molecular dynamics simulations to assess for spin relaxation effects on chemical reactions with realistically modelled protein motion, relevant for studying radical pair reactions at finite temperature., (© 2024 The Authors. ChemPhysChem published by Wiley-VCH GmbH.)

Ileoanal pouch-related fistula (IAPRF) is a possible complication after ileal pouch-anal anastomosis that significantly impacts pouch prognosis and the patient's quality of life. This study aimed to perform a comprehensive narrative review to better classify the epidemiology, risk factors, etiology, management, and outcomes of IAPRF, and to propose an algorithm for its systematic classification. Ten studies comprising 664 patients with IAPRF were identified, with a prevalence ranging from 4% to 45%. The reported fistula types were as follows: pouch-vaginal (n = 236, 35.5%), perineal (n = 139, 21%), enterocutaneous (n = 54, 8%), pouch-anal (n = 53, 8%), presacral (n = 18, 2%), and anastomotic (n = 15, 2%). Postsurgical pelvic sepsis occurred in 21%-37.2% of patients. Twenty additional studies regarding fistula classification divided them according to onset time and etiology, defining 5 categories: anastomotic-related, technical aspects of the surgery, Crohn's disease-like pouch inflammation, cryptoglandular, and malignancy. Pouch excision was reported in up to 70% of patients. Fistulas associated with anastomotic complications, technical surgical issues, and cryptoglandular fistulas warrant surgical management. On the other hand, fistulas associated with inflammation are preferentially managed with biologics or small molecules., (© The Author(s) 2024. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Knee osteoarthritis prevalently causes significant pain, activity limitations, psychological distress, and reduced quality of life. Despite lower limb strength training being a core treatment for knee osteoarthritis, adherence remains a challenge, prompting the exploration of virtual reality (VR) to improve exercise compliance. Recent research suggests the potential of VR in providing enhanced pain management and functional outcomes for knee osteoarthritis, necessitating further exploration of immersive VR technology., Objective: We aimed to study the feasibility, acceptability, and preliminary efficacy of an immersive VR-assisted lower limb strength training for knee osteoarthritis (VRiKnee)., Methods: A convergent, parallel, mixed methods study was conducted in 30 participants with knee osteoarthritis. After 1:1 randomization, the VRiKnee group (n=15) was assigned to perform repetitive concentric quadriceps and isometric vastus medialis oblique exercise in an immersive environment using a head-mounted display for 12 weeks. The control group (n=15) completed the same exercises without VRiKnee. VRiKnee participants were interviewed at week 12 to study VRiKnee acceptability and user experience. Quantitative data included feasibility outcomes such as recruitment, dropout, and exercise adherence rates, and effectiveness outcomes such as the numeric rating scale, the Western Ontario and McMaster Universities Osteoarthritis Index (100 points) pain and function subscales, and objective physical activity measured by metabolic equivalents of task using an ActivPAL accelerometer. Qualitative data were analyzed by thematic analysis, followed by integration with quantitative data using joint displays., Results: The recruitment rate was 100% (N=30), with enrollment of 30 participants in 7.57 weeks. The median age was 63.5 (IQR 61.8-66.3) years, with 76% (n=23) being female. The response rates were 80% and 93% for the VRiKnee and control groups. Dropout rates were 13% for VRiKnee and 7% for the control group. Median exercise adherence was 77% (IQR 37-104%) for VRiKnee and 62% (IQR 40-166%) for the control group, respectively, with adherence reduction over this study's period and no significant intergroup differences (P=.82). No statistically significant differences were observed in primary and secondary outcomes, though positive trends were observed in pain and stiffness. Cybersickness was reported by 5 (33%) participants in the VRiKnee group. In the qualitative analysis, 4 themes, 11 subthemes, and 16 quotes were generated, identifying facilitators and barriers with practical suggestions to enhance the usability of VRiKnee., Conclusions: VRiKnee demonstrated feasibility, acceptability, and potential efficacy in managing knee osteoarthritis. Future trials of larger sample sizes and better VR designs will confirm its role in clinical practice., (© Hermione Hin Man Lo, Marques Ng, Pak Yiu Hugo Fong, Harmony Hoi Ki Lai, Bo Wang, Samuel Yeung-shan Wong, Regina Wing Shan Sit. Originally published in JMIR Serious Games (https://games.jmir.org).)

Phototransduction in vertebrate photoreceptor cells is controlled by Ca 2+ -dependent feedback loops involving the membrane-bound guanylate cyclase GC-E that synthesizes the second messenger guanosine-3',5'-cyclic monophosphate. Intracellular Ca 2+ -sensor proteins named guanylate cyclase-activating proteins (GCAPs) regulate the activity of GC-E by switching from a Ca 2+ -bound inhibiting state to a Ca 2+ -free/Mg 2+ -bound activating state. The gene GUCY2D encodes for human GC-E, and mutations in GUCY2D are often associated with an imbalance of Ca 2+ and cGMP homeostasis causing retinal disorders. Here, we investigate the Ca 2+ -dependent inhibition of the constitutively active GC-E mutant V902L. The inhibition is not mediated by GCAP variants but by Ca 2+ replacing Mg 2+ in the catalytic center. Distant from the cyclase catalytic domain is an α-helical domain containing a highly conserved helix-turn-helix motif. Mutating the critical amino acid position 804 from leucine to proline left the principal activation mechanism intact but resulted in a lower level of catalytic efficiency. Our experimental analysis of amino acid positions in two distant GC-E domains implied an allosteric communication pathway connecting the α-helical and the cyclase catalytic domains. A computational connectivity analysis unveiled critical differences between wildtype GC-E and the mutant V902L in the allosteric network of critical amino acid positions.

Purpose: Osteoporosis is an important public health challenge given its high prevalence in western populations and the prevalence has shown an upward trend in recent decades in Asia. However, epidemiological evidence on the association between bone mineral density (BMD) and mortality risk in the Asian population is sparse., Methods: The Cox proportional hazards model and cause-specific hazard models were used to investigate the association of BMD with the risk of all-cause mortality and cause-specific mortality., Results: The present study comprised of 3,332,207 person-years with a median follow-up of 14.6 years. 27,508 participants (15,967 men and 11,541 women) died among 233,397 participants (112,348 men and 121,049 women) during the follow-up period. Compared to those with normal BMD level, both men and women with low BMD had a significantly higher risk of all-cause, cardiovascular disease (CVD), and cancer mortality after adjusting for the covariates. [For men with osteoporosis: all-cause: 1.37 (1.27-1.49); CVD: 1.28 (1.08-1.52); cancer: 1.29 (1.12-1.49); For women with osteoporosis: all-cause: 1.72 (1.63-1.82); CVD: 1.85 (1.64-2.08); cancer: 1.47 (1.35-1.61)]. The P for interactions for BMD with sex were significant for all-cause and CVD mortality. The adverse effects of BMD on the risk of all-cause and CVD were higher in women than in men [men vs. women: all-cause: 1.37 (1.27-1.49) vs. 1.72 (1.63-1.82); CVD: 1.28 (1.08-1.52) vs. 1.85 (1.64-2.08)]. In the nonlinear dose-response analyses, the association between BMD increments and all-cause mortality risk shows an L-shaped pattern in men and a similar U-shaped trend in women (P for non-linear association: <0.001). Likewise, a similar L-shaped association was observed between BMD levels and cancer mortality risk in men., Conclusions: Low BMD had an increased risk of all-cause, CVD, and cancer mortality in both men and women. Women had a stronger positive association between low BMD and an increased risk of all-cause and CVD mortality compared to men., Competing Interests: Declaration of competing interest We declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: This study aims to investigate age- and gender-specific effects of household solid fuels for heating on major depression and buffering effects of outdoor time in a high-income country., Methods: Data were obtained from the UK Biobank. Participants with complete information on our studied variables and no prior diagnosis of major depression at baseline were included. Cox proportional hazards regression models were used to examine the effects of household solid fuels for heating on major depression. Subgroup analyses were conducted to investigate the buffering effects of outdoor time in summer and winter. Sensitivity analyses were performed to test the robustness of the main findings., Results: Of 255,505 participants (50.2 % women), the 12-year cumulative incidence of major depression was 4.4 %. Household solid fuels for heating increased the risk of major depression only in women aged <45 years (HR (95%CI) = 1.30 (1.04, 1.63)). In this group, the solid fuel effect was moderated by outdoor time spending both in summer (HR (95%CI), ≤2 h/day: 1.61 (1.13, 2.28); >2 h/day: 1.13 (0.84, 1.52)) and winter (≤1 h/day: 1.35 (1.01, 1.08); >1 h/day: 1.24 (0.86, 1.77))., Limitations: Self-reported measures might lead to recall bias and some potential confounders, such as ventilation efficiency, were not measured and controlled in data analyses., Conclusions: Younger women are more vulnerable to the impact of domestic air pollution on major depression. Promoting outdoor activities is a cost-effective and efficient approach to mitigating the risk of major depression caused by household solid fuels., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier B.V.)

Complete chloroplast genomes of 17 samples from six species of Colocasia (Araceae) were sequenced, assembled, and aligned together with two previously reported complete genome sequences from taro ( Colocasia esculenta ). Analysis provides a well-supported phylogenetic tree for taro and closely-related wild Colocasia species in Southeast Asia. Two chloroplast lineages (CI and CII) form a well-defined haplotype group and are found in cultivated taros known as var. esculenta (dasheen, CI), var. antiquorum (eddoe, CII), and in a widespread, commensal wild form known as var. aquatilis (CI). A third lineage (CIII) is also found in wild taros known as var. aquatilis and in the wild species C. lihengiae , C. formosana , and C. spongifolia . We suggest three different scenarios to explain the grouping of CIII wild taros ( C. esculenta ) with other wild Colocasia species. Chloroplast lineages CI and CIII in C. esculenta and an unknown parent species may be involved in an as yet undated history of hybridization, chloroplast capture, and range extension. Substantial taxonomic revision may be needed for C. esculenta after further studies of morphological and genetic diversity within the crop, in wild populations, and in closely related wild species. The results also point to the Bengal delta as a region of key interest for future research on the origins of tropical wetland taros., Competing Interests: The authors have no conflicts of interest to declare., (© 2024 The Author(s). Ecology and Evolution published by John Wiley & Sons Ltd.)

Background: Virtual reality (VR) in different immersive conditions has been increasingly used as a nonpharmacological method for managing chronic musculoskeletal pain., Objective: We aimed to assess the effectiveness of VR-assisted active training versus conventional exercise or physiotherapy in chronic musculoskeletal pain and to analyze the effects of immersive versus nonimmersive VR on pain outcomes., Methods: This systematic review of randomized control trials (RCTs) searched PubMed, Scopus, and Web of Science databases from inception to June 9, 2024. RCTs comparing adults with chronic musculoskeletal pain receiving VR-assisted training were included. The primary outcome was pain intensity; secondary outcomes included functional disability and kinesiophobia. Available data were pooled in a meta-analysis. Studies were graded using the Cochrane Risk-of-Bias Tool version 2., Results: In total, 28 RCTs including 1114 participants with some concerns for a high risk of bias were identified, and 25 RCTs were included in the meta-analysis. In low back pain, short-term outcomes measured post intervention showed that nonimmersive VR is effective in reducing pain (standardized mean difference [SMD] -1.79, 95% CI -2.72 to -0.87; P<.001), improving disability (SMD -0.44, 95% CI -0.72 to -0.16; P=.002), and kinesiophobia (SMD -2.94, 95% CI -5.20 to -0.68; P=.01). Intermediate-term outcomes measured at 6 months also showed that nonimmersive VR is effective in reducing pain (SMD -8.15, 95% CI -15.29 to -1.01; P=.03), and kinesiophobia (SMD -4.28, 95% CI -8.12 to -0.44; P=.03) compared to conventional active training. For neck pain, immersive VR reduced pain intensity (SMD -0.55, 95% CI -1.02 to -0.08; P=.02) but not disability and kinesiophobia in the short term. No statistical significances were detected for knee pain or other pain regions at all time points. In addition, 2 (8%) studies had a high risk of bias., Conclusions: Both nonimmersive and immersive VR-assisted active training is effective in reducing back and neck pain symptoms. Our study findings suggest that VR is effective in alleviating chronic musculoskeletal pain., Trial Registration: PROSPERO CRD42022302912; https://www.crd.york.ac.uk/prospero/display&#95;record.php?RecordID=302912., (©Hermione Hin Man Lo, Mengting Zhu, Zihui Zou, Cho Lee Wong, Suzanne Hoi Shan Lo, Vincent Chi-Ho Chung, Samuel Yeung-Shan Wong, Regina Wing Shan Sit. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 19.08.2024.)

High-sugar intake is a risk factor for chronic diseases such as cardiovascular disease and type 2 diabetes, but less is known about its role in anxiety disorders. This systematic review aimed to systematically synthesise and assess the existing evidence regarding the association between dietary sugars intake and anxiety disorders. Following PRISMA guidelines, a systematic search of PubMed, MEDLINE, Embase, APA PsycArticles and APA PsycINFO was conducted up to 19th August 2022. Study quality was assessed by the Newcastle-Ottawa scale (NOS) and the Cochrane risk of bias tool. Eleven studies (10 cross-sectional and 1 randomised controlled trial [RCT]) were included. Seven cross-sectional studies had very good quality or good quality, and the quality of the RCT was at low risk of bias. These studies examined sugar-sweetened beverages (n = 7), sugar-sweetened foods (n = 4) and/or added sugar (n = 5). The findings suggest a possible positive relationship of added sugar consumption with anxiety disorders, with age as a potential moderator in such association. No conclusions can be drawn on the associations between sugar-sweetened beverages, sugar-sweetened foods consumption and anxiety disorders. Due to the included studies being mostly cross-sectional, the conclusions drawn from the existing evidence should be interpreted with caution. The longitudinal design is warranted to investigate any causal relationship and the potential mechanisms underlying these heterogeneous results. The potential difference in effect at different ages observed in this review should be further examined., (© 2024 The Author(s). Nutrition Bulletin published by John Wiley & Sons Ltd on behalf of British Nutrition Foundation.)

Background & Aims: Perianal fistulation is a challenging phenotype of Crohn's disease, with significant impact on quality of life. Historically, fistulae have been classified anatomically in relation to the sphincter complex, and management guidelines have been generalized, with lack of attention to the clinical heterogenicity seen. The recent 'TOpClass classification system' for perianal fistulizing Crohn's disease (PFCD) addresses this issue, and classifies patients into defined groups, which provide a focus for fistula management that aligns with disease characteristics and patient goals. In this article, we discuss the clinical applicability of the TOpClass model and provide direction on its use in clinical practice., Methods: An international group of perianal clinicians participated in an expert consensus to define how the TOpClass system can be incorporated into real-life practice. This included gastroenterologists, inflammatory bowel disease surgeons, and radiologists specialized in PFCD. The process was informed by the multi-disciplinary team management of 8 high-volume fistula centres in North America, Europe, and Australia., Results: The process produced position statements to accompany the classification system and guide PFCD management. The statements range from the management of patients with quiescent perianal disease to those with severe PFCD requiring diverting-ostomy and/or proctectomy. The optimization of medical therapies, as well as the use of surgery, in fistula closure and symptom management is explored across each classification group., Conclusion: This article provides an overview of the system's use in clinical practice. It aims to enable clinicians to have a pragmatic and patient goal-centered approach to medical and surgical management options for individual patients with PFCD., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background and Aims: We aimed to assess the relationship between smoking status and carotid atherosclerosis (CA) with different manifestations and to explore the underlying mechanisms., Methods and Results: A total of 60,655 middle-aged and elderly participants were recruited. Logistic regression models were used to examine the association of smoking, various blood indexes [i.e., blood pressure, blood lipid, glycated hemoglobin (HbA1c) and homocysteine (Hcy)] with CA in different manifestations including carotid intima-media thickness (cIMT), plaques, and stenosis. Compared with nonsmokers, current smokers were associated with a higher prevalence of CA (OR = 3.48, 95%CI: 3.21-3.77) and its specific manifestations including cIMT (OR = 2.66, 95%CI: 2.42-2.93), plaques (OR = 3.67, 95%CI: 3.35-4.02) and stenosis (OR = 2.04, 95%CI: 1.64-2.54), after adjusting for potential confounders. Former smokers were also associated with an increased prevalence of CA (OR = 1.82, 95%CI: 1.54-2.14), cIMT (OR = 1.39, 95%CI: 1.14-1.69), plaques (OR = 2.04, 95%CI: 1.71-2.44) and stenosis (OR = 1.72, 95%CI: 1.18-2.51), but the associations were consistently weaker than that of the current smokers. The prevalence of CA, cIMT, plaques and stenosis among current smokers was positively associated with pack-years of cigarette smoking, partially mediated by SBP, HbA1c, TG, HDL-C and Hcy with a mediated proportion of 1.12%, 3.28%, 6.33%, 6.01% and 12.7%, respectively. Stratified analysis by sex showed a significantly higher CA among the current male smokers than females., Conclusions: Current and former smoking was associated with increased carotid atherosclerosis, predominantly by current male smokers. A positive gradient between pack-years and carotid atherosclerosis among current smokers is partially mediated by SBP, HbA1c, TG, HDL-C and Hcy., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Overgeneralization and a lack of baseline data for microorganisms in high-latitude environments have restricted the understanding of the microbial response to climate change, which is needed to establish Antarctic conservation frameworks. To bridge this gap, we examined over 17,000 sequence variants of bacteria and microeukarya across the hyperarid Vestfold Hills and Windmill Islands regions of eastern Antarctica. Using an extended gradient forest model, we quantified multispecies response to variations along 79 edaphic gradients to explore the effects of change and wind-driven dispersal on community dynamics under projected warming trends. We also analyzed a second set of soil community data from the Windmill Islands to test our predictions of major environmental tipping points. Soil moisture was the most robust predictor for shaping the regional soil microbiome; the highest rates of compositional turnover occurred at 10-12% soil moisture threshold for photoautotrophs, such as Cyanobacteria, Chlorophyta, and Ochrophyta. Dust profiles revealed a high dispersal propensity for Chlamydomonas, a microalga, and higher biomass was detected at trafficked research stations. This could signal the potential for algal blooms and increased nonendemic species dispersal as human activities increase in the region. Predicted increases in moisture availability on the Windmill Islands were accompanied by high photoautotroph abundances. Abundances of rare oligotrophic taxa, such as Eremiobacterota and Candidatus Dormibacterota, which play a crucial role in atmospheric chemosynthesis, declined over time. That photosynthetic taxa increased as soil moisture increased under a warming scenario suggests the potential for competition between primary production strategies and thus a more biotically driven ecosystem should the climate become milder. Better understanding of environmental triggers will aid conservation efforts, and it is crucial that long-term monitoring of our study sites be established for the protection of Antarctic desert ecosystems. Furthermore, the successful implementation of an improved gradient forest model presents an exciting opportunity to broaden its use on microbial systems globally., (© 2024 The Authors. Conservation Biology published by Wiley Periodicals LLC on behalf of Society for Conservation Biology.)

Surgical site infection (SSI) caused by pathogenic bacteria leads to delayed wound healing and extended hospitalization. Inappropriate uses of antibiotics have caused a surge in SSI and common antibiotics are proving to be ineffective against SSI. Antimicrobial peptides (AMPs) can be a potential solution to prevent SSI because of their broad spectrum of antimicrobial activities. In this study, naturally sourced AMPs were studied along with microfibers, fabricated by a novel wet-spinning method using sodium alginate and polycaprolactone. Afterward, fibers were functionalized by the catechol groups of dopamine immobilizing nucleophilic AMPs on the surface. Conjugation between PCL and alginate resulted in fibers with smooth surfaces improving their mechanical strength via hydrogen bonds. Having an average diameter of 220 μm, the mechanical properties of the fiber complied with USP standards for suture size 3-0. Engineered microfibers were able to hinder the growth of Proteus spp., a pathogenic bacterium for at least 60 hours whereas antibiotic ceftazidime failed. When subjected to a linear incisional wound model study, accelerated healing was observed when the wound was closed using the engineered fiber compared to Vicryl. The microfibers promoted faster re-epithelialization compared to Vicryl proving their higher wound healing capacity.

Background: Previous literature lacks summative information on the mental health benefits achieved from different forms of walking., Objective: The aim of this study was to assess the effectiveness of different forms of walking in reducing symptoms of depression and anxiety., Methods: This was a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of walking on depressive and anxiety symptoms. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Allied and Complementary Medicine Database (AMED), CINAHL, and Web of Science were searched on April 5, 2022. Two authors independently screened the studies and extracted the data. Random-effects meta-analysis was used to synthesize the data. Results were summarized as standardized mean differences (SMDs) with 95% CIs in forest plots. The risk of bias was assessed by using the Cochrane Risk of Bias tool., Results: This review included 75 RCTs with 8636 participants; 68 studies reported depressive symptoms, 39 reported anxiety symptoms, and 32 reported both as the outcomes. One study reported the results for adolescents and was not included in the meta-analysis. The pooled results for adults indicated that walking could significantly reduce depressive symptoms (RCTs: n=44; SMD -0.591, 95% CI -0.778 to -0.403; I2=84.8%; τ2=0.3008; P<.001) and anxiety symptoms (RCTs: n=26; SMD -0.446, 95% CI -0.628 to -0.265; I2=81.1%; τ2=0.1530; P<.001) when compared with the inactive controls. Walking could significantly reduce depressive or anxiety symptoms in most subgroups, including different walking frequency, duration, location (indoor or outdoor), and format (group or individual) subgroups (all P values were <.05). Adult participants who were depressed (RCTs: n=5; SMD -1.863, 95% CI -2.764 to -0.962; I2=86.4%; τ2=0.8929) and those who were not depressed (RCTs: n=39; SMD -0.442, 95% CI -0.604 to -0.280; I2=77.5%; τ2=0.1742) could benefit from walking effects on their depressive symptoms, and participants who were depressed could benefit more (P=.002). In addition, there was no significant difference between walking and active controls in reducing depressive symptoms (RCTs: n=17; SMD -0.126, 95% CI -0.343 to 0.092; I2=58%; τ2=0.1058; P=.26) and anxiety symptoms (14 RCTs, SMD -0.053, 95% CI -0.311 to 0.206, I2=67.7%, τ2=0.1421; P=.69)., Conclusions: Various forms of walking can be effective in reducing symptoms of depression and anxiety, and the effects of walking are comparable to active controls. Walking can be adopted as an evidence-based intervention for reducing depression and anxiety. More evidence on the effect of low-intensity walking is needed in the future., (© Zijun Xu, Xiaoxiang Zheng, Hanyue Ding, Dexing Zhang, Peter Man-Hin Cheung, Zuyao Yang, King Wa Tam, Weiju Zhou, Dicken Cheong-Chun Chan, Wenyue Wang, Samuel Yeung-Shan Wong. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).)

Our skin provides a protective barrier that shields us from our environment. Barrier function is typically associated with the interfollicular epidermis; however, whether hair follicles influence this process remains unclear. Here, we utilize a potent genetic tool to probe barrier function by conditionally ablating a quintessential epidermal barrier gene, Abca12, which is mutated in the most severe skin barrier disease, harlequin ichthyosis. With this tool, we deduced 4 ways by which hair follicles modulate skin barrier function. First, the upper hair follicle (uHF) forms a functioning barrier. Second, barrier disruption in the uHF elicits non-cell-autonomous responses in the epidermis. Third, deleting Abca12 in the uHF impairs desquamation and blocks sebum release. Finally, barrier perturbation causes uHF cells to move into the epidermis. Neutralizing IL-17a, whose expression is enriched in the uHF, partially alleviated some disease phenotypes. Altogether, our findings implicate hair follicles as multi-faceted regulators of skin barrier function., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)