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Heavy metal (HM) toxicity of agricultural soils poses a major risk to plant health, human life, and global food chain. Crop output and health are negatively impacted when HM levels in agricultural soils reach hazardous points. The nano-biochar (nano-BC) mediated stress tolerance has attracted growing scientific interest because biochar has the potential to be a novel and sustainable solution that may be actively included into the development of sustainable agriculture and food production. At present, biochar is extensively employed as a powerful tool to enhance sustainable agriculture with minimal impact on ecosystems and the environment. Nano-BC offers improved surface area, adsorption and mobility properties in soil compared to traditional fertilizers. Furthermore, nano-BC may prove to be the most practical substitute for traditional waste management techniques because of its affordability, sustainability, and environmental friendliness. In this review, we examine the application of nano-BC in the regulation of HM stress tolerance for improving plant growth and development. We focus on the impact of HMs impact on crop productivity, nano-BC amendments, their application, and production. The article also explores the nano-BC risk and toxicity. Through the perspective of multidisciplinary research, this work highlights the significance of nano-BC as cutting-edge tools in the field of agriculture, igniting a paradigm shift toward sustainable and stress-resilient farming systems.

Plant annexins are a multigene family of phospholipid-binding, calcium-dependent proteins that respond to signals and environmental challenges as plants grow and develop. Plant annexins are functionally unique due to their ATPase/GTPase, peroxidase, and calcium (Ca2+) channel-regulating activities. They play a major role in controlling many different aspects of cellular and metabolic functions, plant growth and development, and reactions to both biotic and abiotic environmental stimuli. In this review, we provide an overview of how intracellular and extracellular annexins work, mechanism of reactive oxygen species (ROS) and annexins, highlight recent developments of the roles of annexins in abiotic stress tolerance in plants, and emphasize the role of annexins in plant growth and development.

Purpose: Zoledronic acid can inhibit the activity of osteoclasts, and thus, may slow or inhibit bone loss. The purpose of this study was to systematically evaluate the efficacy and safety of zoledronic acid in the treatment of osteoporosis. Methods: Four databases, PubMed, Embase, Cochrane Library, and Web of Science, were systematically searched up to December 26, 2022. The primary outcomes included bone mineral density (BMD), carboxy-terminal cross-linked telopeptide of type 1 collagen (CTX), bone-specific alkaline phosphatase (BSAP), procollagen type 1 N-terminal prope-ptide (P1NP), adverse events, and fracture. Secondary outcomes included serum sclerostin level, Visual Analogue Scale (VAS) score, and Oswestry Disability Index (ODI). Results: A total of 22 randomized controlled trials were included in this meta-analysis. Meta-analysis results showed that zoledronic acid was effective in increasing BMD of the lumbar spine, femoral neck, trochanter and serum sclerostin level; and reduced CTX, BSAP, P1NP, VAS score, and ODI in patients with osteoporosis. Regarding safety, zoledronic acid could reduce the incidence of fractures but had relatively more adverse events. Conclusion: Zoledronic acid can significantly improve BMD of the lumbar spine, femoral neck and trochanter, and effectively reduce incidence of fracture in patients with osteoporosis, thereby significantly improving patients' quality of life. However, the incidence of adverse events was higher than that of patients treated with placebo.

Computational methods coupled with experimental validation play a critical role in the identification of novel inhibitory peptides that interact with viral antigenic determinants. The interaction between the receptor binding domain (RBD) of SARS-CoV-2 spike protein and the helical peptide of human angiotensin-converting enzyme-2 (ACE2) is a necessity for the initiation of viral infection. Herein, natural orthologs of human ACE2 helical peptide were evaluated for competitive inhibitory binding to the viral RBD by use of a computational approach, which was experimentally validated. A total of 624 natural ACE2 orthologous 32-amino acid long peptides were identified through a similarity search. Molecular docking was used to virtually screen and rank the peptides based on binding affinity metrics, benchmarked against human ACE2 peptide docked to the RBD. Molecular dynamics (MD) simulations were done for the human reference and the Nipponia nippon peptide as it exhibited the highest binding affinity (Gibbs free energy; −14 kcal/mol) predicted from the docking results. The MD simulation confirmed the stability of the assessed peptide in the complex (−12.3 kcal/mol). The top three docked-peptides (from Chitinophaga sancti, Nipponia nippon, and Mus musculus) and the human reference were experimentally validated by use of surface plasmon resonance technology. The human reference exhibited the weakest binding affinity (Kd of 318–441 pM) among the peptides tested, in agreement with the docking prediction, while the peptide from Nipponia nippon was the best, with 267–538-fold higher affinity than the reference. The validated peptides merit further investigation. This work showcases that the approach herein can aid in the identification of inhibitory biosimilar peptides for other viruses.

Background & Aims: AXL and MERTK expression on circulating monocytes modulated immune responses in patients with cirrhosis (CD14+HLA-DR+AXL+) and acute-on-chronic liver failure (CD14+MERTK+). AXL expression involved enhanced efferocytosis, sustained phagocytosis, but reduced tumor necrosis factor-α/interleukin-6 production and T-cell activation, suggesting a homeostatic function. Axl was expressed on murine airway in tissues contacting the external environment, but not interstitial lung- and tissue-resident synovial lining macrophages. Here, we assessed AXL expression on tissue macrophages in patients with cirrhosis. Methods: Using multiplexed immunofluorescence we compared AXL expression in liver biopsies in cirrhosis (n = 22), chronic liver disease (n = 8), non-cirrhotic portal hypertension (n = 4), and healthy controls (n = 4). Phenotype and function of isolated primary human liver macrophages were characterized by flow cytometry (cirrhosis, n = 11; control, n = 14) ex vivo. Also, AXL expression was assessed on peritoneal (n = 29) and gut macrophages (n = 16) from cirrhotic patients. Regulation of AXL expression was analyzed in vitro and ex vivo using primary hepatic stellate cells (HSCs), LX-2 cells, and GAS6 in co-culture experiments. Results: AXL was expressed on resident (CD68+) but not tissue-infiltrating (MAC387+) liver macrophages, hepatocytes, HSCs, or sinusoidal endothelial cells. Prevalence of hepatic CD68+AXL+ cells significantly decreased with cirrhosis progression: (healthy, 90.2%; Child-Pugh A, 76.1%; Child-Pugh B, 64.5%; and Child-Pugh C, 18.7%; all P < .05) and negatively correlated with Model for End-Stage Liver Disease and C-reactive protein (all P < .05). AXL-expressing hepatic macrophages were CD68highHLA-DRhighCD16highCD206high. AXL expression also decreased on gut and peritoneal macrophages from cirrhotic patients but increased in regional lymph nodes. GAS6, enriched in the cirrhotic liver, appeared to be secreted by HSCs and down-regulate AXL in vitro. Conclusions: Decreased AXL expression on resident liver macrophages in advanced cirrhosis, potentially in response to activated HSC-secreted GAS6, suggests a role for AXL in the regulation of hepatic immune homeostasis.

Creating a positive motivational climate in an online course can engage students in their learning. Instructors may be able to better manage their courses and create a positive motivational climate if they implement online survey tools that allow them to assess the motivational climate of their courses. Teachers and researchers have documented that five student perceptions—empowerment, usefulness, success, interest, and caring—are particularly important for creating a positive motivational climate and are associated with students’ engagement and evaluations of teaching. In this paper, we describe a case study of an instructor who used an online survey tool to assess the motivational climate in his online asynchronous course over time. He then used the feedback to consider improvements that he could make to his course in the future. In addition, we describe how this process of using the online survey tool could be used by instructors to transform education.

Objectives: Women with polycystic ovary syndrome (PCOS) have an increased cardiometabolic risk. Similarly, it was previously shown that atherosclerotic and cardiovascular risk is increased in the general population with lower serum Klotho levels. The aim of this study was to investigate the lotho and thiol/disulfide levels in women with non-obese PCOS compared to healthy controls and also to investigate the relationship of serum Klotho and thiol/disulfide homeostasis with cardiometabolic risk factors. Materials and methods: In this prospective case control study, human serum alpha Klotho levels and thiol/disulfide homeostasis of women with PCOS aged between 19-33 were compared to their age and BMI matched non – PCOS healthy controls. In addition, the correlation of these molecules with other metabolic markers/measurements were also investigated. Results: Metabolic parameters such as mean waist circumference, lipid accumulation product, visceral adiposity index, fasting insulin, homeostasis model assessment of insulin resistance and triglyceride values were higher in the PCOS group (p = 0.038, p = 0.008, p = 0.001, p = 0.001, p = 0.002 and p = 0.002, respectively) compared to controls. However, mean serum Klotho and native thiol levels (respectively p

Purpose: The aim of the present study was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies on handgrip strength and health outcomes. Methods: An umbrella review of systematic reviews with meta-analyses of observational studies was conducted. We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p values, 95% prediction intervals, heterogeneity, small-study effects, and excess significance. We graded the evidence from convincing (Class I) to weak (Class IV). Results: From 504 articles returned in a search of the literature, 8 systematic reviews were included in our review, with a total of 11 outcomes. Overall, nine of the 11 of the outcomes reported nominally significant summary results (p < 0.05), with 4 associations surviving the application of the more stringent p value (p

BACKGROUND & AIMS: Hydroxychloroquine (HCQ) and chloroquine (CQ) are anti-malarial drugs frequently used in the rheumatologic field. They were recently identified as potential therapeutic options for Coronavirus Disease (COVID-19). The present study aims to map and grade the diverse health outcomes associated with HCQ/CQ using an umbrella review approach. METHODS: Umbrella review of systematic reviews of observational and intervention studies. For observational studies, random-effects summary effect size, 95% confidence interval, and 95% prediction interval were estimated. We also assessed heterogeneity, evidence for small-study effect, and evidence for excess significance bias. The quality of evidence was then graded using validated criteria from highly convincing to weak. The evidence from randomized controlled trials (RCTs) was graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. RESULTS: From 313 articles returned in the literature search, six meta-analyses were included (n = 25 outcomes). Among meta-analyses (MAs) of observational studies, HCQ/CQ are weakly associated with a reduced risk for cardiovascular events and diabetes when used for autoimmune diseases and with spontaneous abortion; they are also associated with a higher risk of death in COVID-19 patients. Among MAs of RCTs, HCQ/CQ are associated with an improvement of articular manifestations of rheumatic diseases. CONCLUSIONS: There is high evidence of the efficacy of HCQ/CQ in the rheumatologic field. The lack of evidence for efficacy and the risk of death associated with the use of HCQ/CQ for COVID-19 indicate the inappropriateness of their inclusion in recent COVID-19 therapy guidelines and the urgent need for RCTs to determine eventual appropriateness as a COVID-19 therapy.

Raoultella planticola is rarely associated with clinical infection, and a limited number of pediatric cases have been reported. Herein we report a case of bacteremia presumptively secondary to bilateral conjunctivitis in an infant caused by R. planticola which was successfully treated with piperacillin-tazobactam. It should be kept in mind that R. planticola can be a pathogen in pediatric age groups. Keywords: Infant, Conjunctivitis, Bacteremia, Raoultella

Although Saccharomyces boulardii is usually a non-pathogenic fungus, in rare occasions it can cause invasive infection in children. We present the case of an 8-year-old patient in pediatric surgical intensive care unit who developed S. cerevisiae fungemia following probiotic treatment containing S. boulardii. Caspofungin was not effective in this case and he was treated with amphotericin B. We want to emphasize that physicians should be careful about probiotic usage in critically ill patients.

Objectives: The purpose of this study to determinate whether there is a relationship between the nutritional status and white matter integrity in older patients by using Diffusion Tensor Imaging (DTI)., Methods: The patients were evaluated by Mini-Nutritional Assessment Scale. The patients are categorized in the groups of well-nourished, risk of malnutrition, or malnourished, depending on the overall score> 23.5, 17-23.5, or 17; respectively. All patients had brain MRI and DTI. The mean diffusivity (MD), fractional anisotropy (FA), axial diffusivity (AD) and radial diffusivity (RD) values were calculated by ROI-based method in white matter tracts., Results: Total of the 224 patients; 86 patients had normal nutrition status (group 1), 107 patients were diagnosed with malnutrition risk (group 2) and 31 patients were diagnosed with malnutrition (group 3). Significantly decreased FA values of genu of corpus callosum, forceps minor and significantly increased MD values of middle cerebellar peduncle, and superior frontooccipital fasciculus were detected in group 2 in comparison to group 1 (p < 0.05). After adjusting for the folate and age, MD and RD values of cingulum remained significantly higher and the AD values of superior cerebellar peduncle remained significantly lower in group 3 (p < 0.05)., Conclusions: Malnutrition was associated with deteriorated DTI values, especially in cingulum and superior cerebellar peduncle. Assessing the nutritional status of older individuals is crucial to avoid its negative impact on brain., Advances in Knowledge: Early diagnosis of malnutrition-related impaired WM integrity is important for prevention and intervention, and DTI is a useful non-invasive technique to be used for this purpose., Competing Interests: Conflicts of interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objectives: Both excessive daytime sleepiness (EDS) and nutritional deficiencies are common and can cause similar negative consequences, such as falls, and cognitive impairment in older adults, but there is no study investigating the relationship between the two. The aim of this study is to investigate the relationship between malnutrition/micronutrient deficiency and EDS in patients with and without dementia., Design: Cross-sectional study., Setting and Participants: A total of 800 outpatients (243 of whom had dementia), aged ≥65 years, were included., Methods: All patients underwent comprehensive geriatric assessment. Mini Nutritional Assessment (MNA) scores >23.5, 17-23.5, or <17 were categorized as well-nourished, malnutrition risk, and malnutrition, respectively. Eating Assessment Tool score of ≥3 was accepted as dysphagia. Serum vitamin B 12 , vitamin D, and folate deficiencies were also evaluated. The Epworth Sleepiness Scale score of ≥11 points indicated EDS., Results: The mean age was 79.1±7.5 years. The prevalence of EDS was 22.75%. In patients with dementia, those with EDS had significantly lower MNA scores and more frequent dysphagia (P < .05). In patients without dementia, those with EDS have lower MNA scores than those without EDS; malnutrition, dysphagia, and vitamin D deficiency were higher (P < .05). In multivariable analysis adjusted for age, gender, living status, ischemic heart disease, cerebrovascular events, polypharmacy, dementia, and insomnia, the association between EDS and malnutrition [odds ratio (OR) 1.73, 95% confidence interval (CI) 1.37-2.20], dysphagia (OR 2.01, 95% CI 1.33-2.88), and vitamin D deficiency (OR 2.0, 95% CI 1.12-3.55) persisted., Conclusions and Implications: There is a significant relationship between EDS and malnutrition risk, dysphagia, and vitamin D deficiency in older adults. Therefore, when examining an older patient with EDS, dysphagia, malnutrition, and vitamin D levels should be evaluated, or EDS should be investigated in an older patient with malnutrition, dysphagia, and vitamin D deficiency. Thus, it will be possible to manage all these conditions more effectively., (Copyright © 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim was to analyse the overall and sex-specific associations between cannabis use and physical activity and sedentary behaviour., Study Design: Cross-sectional analyses from the National Health and Nutrition Examination Survey (NHANES)., Methods: Data on cannabis use and leisure time physical activity and sedentary behaviour from NHANES cycles 2007-2008 to 2015-2016 were analysed. Multivariable regression models were carried out., Results: About 15,822 participants were analysed (mean age ± standard error = 37.5 ± 0.19 years, range 20-59 years). Significantly higher odds were found for being active and ever used cannabis in the overall sample (odds ratio [OR] = 1.2, 95% confidence interval [CI]: 1.1-1.4) and in males (OR = 1.3, 95% CI: 1.1 to 1.5) and females (OR = 1.2, 95% CI: 1.0-1.4), respectively. In respective of sedentary behaviour, ever used cannabis was associated with higher odds of TV viewing ≥2 h/day in the overall sample (OR = 1.2, 95% CI: 1.0-1.4). However, this association was observed in males only (OR = 1.3, 95% CI: 1.1-1.6). Ever used cannabis was associated with total sitting time (beta-coefficient = 0.3, 95%CI: 0.1-0.4), which was more evident in females (beta-coefficient = 0.4, 95% CI: 0.1-0.6)., Conclusions: Cannabis consumption was associated with higher levels of physical activity and sitting time. When intervening to reduce cannabis consumption in the US populations, it may be appropriate to promote physical activity and ensure physical activity is maintained once cannabis consumption is stopped., (Copyright © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background & Aims: Hydroxychloroquine (HCQ) and chloroquine (CQ) are anti-malarial drugs frequently used in the rheumatologic field. They were recently identified as potential therapeutic options for Coronavirus Disease (COVID-19). The present study aims to map and grade the diverse health outcomes associated with HCQ/CQ using an umbrella review approach., Methods: Umbrella review of systematic reviews of observational and intervention studies. For observational studies, random-effects summary effect size, 95% confidence interval, and 95% prediction interval were estimated. We also assessed heterogeneity, evidence for small-study effect, and evidence for excess significance bias. The quality of evidence was then graded using validated criteria from highly convincing to weak. The evidence from randomized controlled trials (RCTs) was graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool., Results: From 313 articles returned in the literature search, six meta-analyses were included (n = 25 outcomes). Among meta-analyses (MAs) of observational studies, HCQ/CQ are weakly associated with a reduced risk for cardiovascular events and diabetes when used for autoimmune diseases and with spontaneous abortion; they are also associated with a higher risk of death in COVID-19 patients. Among MAs of RCTs, HCQ/CQ are associated with an improvement of articular manifestations of rheumatic diseases., Conclusions: There is high evidence of the efficacy of HCQ/CQ in the rheumatologic field. The lack of evidence for efficacy and the risk of death associated with the use of HCQ/CQ for COVID-19 indicate the inappropriateness of their inclusion in recent COVID-19 therapy guidelines and the urgent need for RCTs to determine eventual appropriateness as a COVID-19 therapy., (Copyright © 2020. Published by Elsevier Ltd.)

Background & Aims: Vitamin D deficiency is a public health problem. The resulting data showed that vitamin D is associated not only with calcium homeostasis, skeletal muscle health, but also with some chronic diseases. The aim of the study was to investigate long-term effects of vitamin D deficiency on gait-balance parameters in older adults., Methods: 370 patients who applied to the geriatric outpatient clinic three times at six-months intervals and underwent comprehensive geriatric assessment (CGA), were retrospectively screened. Patients, whose sociodemographic characteristics, systemic diseases and laboratory findings were reviewed, were divided into 3 groups according to basal serum 25-hydroxy D vitamin [25(OH)D] level: Group 1 (<10 ng/mL), Group 2 (10-20 ng/mL), Group 3 (≥20 ng/mL). The balance-gait performance of patients, the 25(OH)D level of whom reached to the sufficient level at the end of 12th month, was compared to other patients by the Performance Oriented Mobility Assessment (POMA) scale., Results: Demographic characteristics and systemic diseases were similar in the groups except for education (p > 0.05). At baseline, Group 1 had lower Basic and Instrumental Activities of Daily Living (ADL), POMA balance and total score (p < 0.05). At the end of 12th month, POMA balance and total scores improved in the Group 1 patients who reached a sufficient 25(OH)D level, however these scores failed to catch Group 3 (p < 0.05). The basal, 6th and 12th month evaluations of three groups showed that mean POMA balance, gait and total scores were better in patients whose 25(OH)D level was ≥20 ng/mL., Conclusions: Vitamin D replacement, especially to severe deficient patients, may improve balance and gait functions in older adults. Therefore, vitamin D deficiency should be screened routinely and treated effectively., Competing Interests: Conflicts of interest All authors declare that they have no conflict of interest., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objectives: There are a few studies showing how nutritional parameters are affected according to dementia subtypes. The aim of this study was to compare the parameters characterizing nutritional status and micronutrient levels according to different dementia subtypes., Design: Cross-sectional study., Setting and Participants: Four hundred forty outpatients aged 65 years or older., Measures: Newly diagnosed patients with dementia, who underwent comprehensive geriatric assessment (CGA), were retrospectively evaluated. The data on CGA including nutritional status (body mass index), Mini-Nutritional Assessment-Short Form, albumin, and micronutrients (vitamin B12, folate, and vitamin D) were recorded., Results: Of the 396 patients, 195 were diagnosed with Alzheimer type dementia, 70 dementia with Lewy body (DLB), 25 with vascular dementia (VaD), 51 with frontotemporal dementia (FTD), and 55 with normal pressure hydrocephalus. The mean age of the study group was 76.87 ± 8.15 years. The prevalence of malnutrition and the risk of malnutrition were 17.17% and 43.18% in patients, with dementia, respectively. The results of ordinal logistic analysis adjusted by age, sex, and all comorbidities, showed that patients with DLB and VaD were more likely to develop malnutrition [odds ratios 6.834 and 5.414, respectively (P < .001)], whereas FTD had a lower risk of developing malnutrition than the other dementia subtypes (odds ratio 2.883, P = .002).There was no difference in terms of other parameters including vitamin B12, folate, and vitamin D (P > .05)., Conclusions: and Implication: There is a close relationship between dementia and malnutrition. Clinical approaches to minimize malnutrition in persons with dementia should include regular screening for malnutrition and its risk factors, avoidance of dietary restrictions, and support of persons at risk for malnutrition with oral nutritional supplements. Moreover, the influence of nutritional status varies in different types of dementia. Nutritional status may be worse in DLB and VaD compared with other types of dementia, whereas nutritional status in FTD is less., (Copyright © 2020 AMDA — The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of this umbrella review was to determine the effect of physical activity/exercise on improving cognitive and noncognitive outcomes in people with MCI (mild cognitive impairment) and dementia., Design: Umbrella review of systematic reviews (SR), with or without meta-analyses (MAs), of randomized controlled trials (RCTs) and observational studies., Settings and Participants: People with MCI or dementia, confirmed through validated assessment measures. Any form of physical activity/exercise was included. As controls, we included participants not following any prespecified physical activity/exercise intervention or following the same standard protocol with the intervention group., Methods: The protocol was registered in PROSPERO (CDR 164197). Major databases were searched until December 31, 2019. The certainty of evidence of statistically significant outcomes was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. SRs' findings, without a formal MA, were reported descriptively., Results: Among 1160 articles initially evaluated, 27 SRs (all of RCTs, 9 without MA) for a total of 28,205 participants with MCI/dementia were included. In patients with MCI, mind-body intervention (standardized mean difference [SMD] = 0.36; 95% confidence intervals [CI] 0.20-0.52; low certainty) and mixed physical activity interventions (SMD = 0.30; 95% CI 0.11-0.49; moderate certainty) had a small effect on global cognition, whereas resistance training (SMD = 0.80; 95% CI 0.29-1.31; very low certainty) had a large effect on global cognition. In people affected by dementia, physical activity/exercise was effective in improving global cognition in Alzheimer disease (SMD = 1.10; 95% CI 0.65-1.64; very low certainty) and in all types of dementia (SMD = 0.48; 95% CI 0.22-0.74; low certainty). Finally, physical activity/exercise improved noncognitive outcomes in people with dementia including falls, and neuropsychiatric symptoms., Conclusions and Implications: Supported by very low-to-moderate certainty of evidence, physical activity/exercise has a positive effect on several cognitive and noncognitive outcomes in people with MCI and dementia, but RCTs, with low risk of bias/confounding, are still needed to confirm these relationships., (Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: Both insomnia and malnutrition are quite common and can cause similar negative consequences, such as falls, depression, and cognitive impairment in older adults, but there is no study investigating the relationship between the 2. The aims were to investigate relationships between insomnia/insomnia severity and Mini Nutritional Assessment (MNA) score and serum nutrient levels., Setting and Participants: Aged 65 years or older, 575 outpatients were included., Methods: MNA scores >23.5, 17-23.5, and <17 were categorized as normal nutritional status, malnutrition risk, and malnutrition, respectively. Serum vitamin B 12 , vitamin D, and folate deficiencies were also evaluated. Insomnia Severity Index (ISI) with scores of 8 and higher indicated insomnia, which was further stratified as mild (8-14), moderate (15-21), or severe (22-28)., Results: The mean age was 73.1 ± 7.7 years, with 73.2% being female. The prevalence of patients with no insomnia, mild insomnia, moderate insomnia, and severe insomnia were 34.4%, 20.9%, 30.1%, and 14.6%, respectively. After adjusting for gender, education, number of drugs, Charlson Comorbidity Index, presence of depression, and Mini-Mental State Examination scores, patients with insomnia had lower MNA scores than those without insomnia (OR = 0.84, 95% CI: 0.7-0.9, P < .001). There were significant relationships between moderate/severe insomnia and the presence of malnutrition and risk of malnutrition (OR = 1.6, 95% CI: 1.0-2.5, P = .046; OR = 1.6, 95% CI: 1.0-2.7, P = .042) and MNA scores (OR = 0.83, 95% CI: 0.7-0.9, P < .001)/OR = 0.82, 95% CI: 0.7-0.9, P < .001). There was no significant difference between insomnia severity status and serum vitamin D, vitamin B 12 , folate levels, or classification of these nutrients (P > .05)., Conclusions/implications: There is a close relationship between MNA scores and insomnia or insomnia severity in older adults. Therefore, when evaluating an older patient with insomnia, malnutrition should be evaluated, or insomnia should also be questioned in an older patient with malnutrition. Thus, more effective management of the 2 can be possible., (Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: Literature regarding dietary protein intake and risk of falls is limited to a few studies with relatively small sample sizes and short follow-ups, which have reported contrasting findings. Thus, we investigated whether dietary protein intake is associated with risk of falls in a large cohort of North American adults., Design: Data were drawn from the Osteoarthritis Initiative, a cohort study, with 8 years of follow-up., Setting and Participants: Community-dwelling adults with knee osteoarthritis or at high risk for this condition., Methods: Dietary protein intake was recorded using the Block Brief 2000 food frequency questionnaire and categorized using gender-specific quartiles (Q). Falls were self-reported in response to the question "Did you fall during the past year?" categorized as yes vs no and made during the 6 visits over 8 years of follow-up. Results are reported as relative risks (RRs), with their 95% confidence intervals (CIs), using a multivariable Poisson regression., Results: The final sample consisted of 4450 adults (mean age 61.2 years, females = 59.6%). Higher dietary protein intake was significantly associated with higher frequency of falls during the year before baseline. After adjusting for 17 potential confounders, people with the greatest amount of protein intake (Q4) had a significantly higher risk of falling over the 8-year follow-up period (RR 1.112, 95% CI 1.027-1.211, P = .009) than those with the lowest protein intake (Q1)., Conclusions/implications: In this cohort of people affected by knee osteoarthritis or at high risk for this condition, high dietary protein intake may increase the risk of falls in older people, but further research is needed to confirm or refute these findings., (Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: Comprehensive Geriatric Assessment (CGA) may not be performed in clinical practice as it takes too much time and requires special training. The Mini-Nutritional Assessment (MNA) is widely used to assess nutritional status in older adults. We aimed to determine whether or not the MNA can estimate frailty status defined by the Fried criteria., Setting and Participants: Six hundred two outpatients aged 65 years or older who underwent the CGA were included the study., Measures: Frailty status was defined by 5 dimensions including shrinking, exhaustion, low levels of activity, weakness, and slowness: 0 for robust, 1-2 for prefrail, and 3-5 for frail. MNA was performed in all participants even if their MNA-Short Form scores were ≥12., Results: Of the 602 outpatients, of whom the mean age was 74.2 ± 8.2 years, 190 participants (31.6%) were considered frail and 218 (36.2%) prefrail. Internal consistency of the MNA had a Cronbach-alpha of 0.701. Interclass correlation coefficient for the test-retest reliability was found as 0.697. MNA with a cut-off point of 22.5 had a sensitivity of 72.1% and a specificity of 91.2% to detect frail participants. MNA with a cut-off point of 25.5 had a sensitivity of 66.9% and a specificity of 85.4% to detect prefrailty. For the estimation of frailty and prefrailty, the area under the receiver operating characteristics curve of MNA was 0.903 and 0.834, respectively., Conclusions: MNA can be a useful tool for frailty screening indicating that 2 common geriatric syndromes, malnutrition and frailty, can be identified by MNA simultaneously in clinical practice., (Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of this study is to demonstrate the ability of the basal metabolic rate (BMR) to detect frailty and sarcopenia in older males., Setting and Participants: A total of 305 male patients undergoing comprehensive geriatric assessment were included in the study., Measures: The frailty status was assessed with the Fried criteria. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People criteria. BMR is calculated by bioimpedance analysis. Areas under the curves (AUCs) of receiver operating characteristic analyses were used to test the predictive accuracy of BMR in detecting sarcopenia., Results: The mean age was 74.52 ± 7.51 years. Among the patients in the sample, 95 (31.1%) had sarcopenia and 55 (18%) had frailty. Patients who had a BMR <1612 kcal/d had a higher frequency of frailty than those who had a BMR ≥1612 kcal/d (67.3 vs 32.7, P < .001). Results were similar for sarcopenia (77.9 vs 22.1, P < .001). When BMR was divided by body surface area (BSA), BMR/BSA with a cut-off of 874 kcal/m 2 had a sensitivity of 80% and a specificity of 68%, and the AUC was 0.82 for BMR/BSA, in diagnosing sarcopenia (P < .01). The participants without sarcopenia had a higher BMR/BSA for the unadjusted (OR = 8.00, 95% CI 4.52-14.19, P < .001) and adjusted analyses (OR = 6.60, 95% CI 3.52-12.38, P < .001)., Conclusions: Older male patients with sarcopenia and frailty have a higher BMR reduction. Therefore, it should be kept in mind that patients with low BMR should alert us to screen sarcopenia and frailty. BMR/BSA may play a role in objective screening to detect sarcopenia in older males., (Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: Inflammation is key risk factor for several conditions in the elderly. However, the relationship between inflammation and frailty is still unclear. We investigated whether higher dietary inflammatory index (DII) scores were associated with higher incidence of frailty in a cohort of North Americans., Design: Longitudinal, with a follow-up of 8 years., Setting: Osteoarthritis Initiative., Participants: A total of 4421 participants with, or at high risk of, knee osteoarthritis., Measurements: DII scores were calculated using the validated Block Brief 2000 Food-Frequency Questionnaire and categorized into sex-specific quartiles. Frailty was defined as 2 out of 3 of the criteria of the Study of Osteoporotic Fracture study (ie, weight loss, inability to rise from a chair 5 times, and poor energy). The strength of the association between baseline DII score and incident frailty was assessed through a Cox's regression analysis, adjusted for potential baseline confounders, and reported as hazard ratios., Results: A total of 4421 community-dwelling participants (2564 female participants; mean age: 61.3 years) without frailty at baseline were identified from the Osteoarthritis Initiative. During 8 years of follow-up, 356 individuals developed frailty (8.2%). Using Cox's regression analysis, adjusting for 11 potential confounders, participants with the highest DII score (quartile 4) had a significantly higher risk of experiencing frailty (hazard ratio 1.37; 95% confidence interval 1.01-1.89; P = .04) compared with participants with the lowest DII score (quartile 1). The association between DII score and frailty was significant only in men., Conclusions: Higher DII scores, indicating a more proinflammatory diet, are associated with higher incidence of frailty, particularly in men., (Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Presence of detailed screening instruments to detect cognitive impairment in the older adults' culture and language is very essential. The Saint Louis University Mental Status Examination (SLUMS) is one of cognitive screening scales used. The aim of the study was to establish the validity and reliability of the Turkish version of SLUMS (SLUMS-T)., Methods: Two hundred seventy-four participants aged 60 years and older admitted to our geriatric clinic were screened for cognitive impairment using SLUMS-T and Mini-Mental State Examination. Internal consistency was analyzed with Cronbach α test. Area under curves of receiver operating characteristic analyses were used to test the predictive accuracy of the SLUMS-T for detecting amnestic mild cognitive impairment (aMCI) and Alzheimer disease (AD) to set an appropriate cut-off point., Results: The SLUMS-T scores were positively correlated with the Mini-Mental State Examination scores of the patients with aMCI and patients with AD and controls (r = 0.687, P < .001; r = 0.880, P < .001; respectively). Internal consistency of the SLUMS-T was Cronbach α = 0.85. It was found that SLUMS-T with a cut-off point of 23 had a sensitivity of 66.6% and a specificity of 72.3% for the diagnosis of aMCI, and with a cut-off point of 20 had a sensitivity of 83.8% and a specificity of 87.3% for the diagnosis of AD., Conclusions: SLUMS-T was demonstrated to have sufficient validity and reliability to evaluate cognitive impairment including MCI among Turkish elderly people., (Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.)