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Morphological information from histopathology slides and molecular profiles from genomic data are important for predicting the staging of lung cancer. However, most deep learning-based prediction results are based on histopathology or genomics alone, which do not fully utilize the complementary information of both and ignore staining differences in histopathology images due to different staining conditions. In this study, we propose a Multimodal Multi-scale Attention Model (MMAM) to predict patients’ lung cancer staging outcomes by end-to-end multimodal fusion of patients' multi-scale histopathology image features with genetic features by augmented attention. The proposed MMAM consists of two phases. In the first phase, a Staining Difference Elimination Network (SDEN) is proposed for stable detection of histopathology image features to eliminate differences arising from different hospital/specimen staining conditions. In the second phase, we design a Multimodal Multi-scale Fusion Network (MMFN) to efficiently fuse different modality features. We have validated our approach on the lung cancer dataset from The Cancer Genome Atlas (TCGA). The results show that the proposed MMAM improves the staging effectiveness of the fusion network of histopathological and genomic features, reduces the effect of appearance variability due to staining differences on blurred pictures, achieves an AUC of 88.51%, and outperforms other popular methods in predicting lung cancer staging. more...

Objective. Recently, imaging genomics has increasingly shown great potential for predicting postoperative recurrence of lung cancer patients. However, prediction methods based on imaging genomics have some disadvantages such as small sample size, high-dimensional information redundancy and poor multimodal fusion efficiency. This study aim to develop a new fusion model to overcome these challenges. Approach. In this study, a dynamic adaptive deep fusion network (DADFN) model based on imaging genomics is proposed for predicting recurrence of lung cancer. In this model, the 3D spiral transformation is used to augment the dataset, which better retains the 3D spatial information of the tumor for deep feature extraction. The intersection of genes screened by LASSO, F-test and CHI-2 selection methods is used to eliminate redundant data and retain the most relevant gene features for the gene feature extraction. A dynamic adaptive fusion mechanism based on the cascade idea is proposed, and multiple different types of base classifiers are integrated in each layer, which can fully utilize the correlation and diversity between multimodal information to better fuse deep features, handcrafted features and gene features. Main results. The experimental results show that the DADFN model achieves good performance, and its accuracy and AUC are 0.884 and 0.863, respectively. This indicates that the model is effective in predicting lung cancer recurrence. Significance. The proposed model has the potential to help physicians to stratify the risk of lung cancer patients and can be used to identify patients who may benefit from a personalized treatment option. more...

Epidemiological studies report that more than half of the people over the age of 65 years suffer from variable sleep problems. In this study, we conducted a cohort study to investigate the relationship between sleep duration, muscle mass, and function within a community-dwelling, elderly Chinese population. Our study population consisted of residents living in the township central hospital of suburban Tianjin, China. We measured muscle strength and walking speed. We divided sleep duration into the following four groups:7 hours, 7-8 hours,8-9 hours, and9 hours. A total of 902 participants completed the 3-year follow-up. We observed a U-shaped relationship between sleep duration and fall risk. Compared with the 7-8-hour group, fall risk within the7-hour group was 3.67 (2.59, 5.42) times higher and fall risk within the9-hour group was 2.35 (1.29, 3.52) times higher. After adjustment, muscle mass declined by -6.82% (-11.27%, -3.83%) in the7-hour group. In summary, we observed a U-shaped relationship between sleep duration and falls. Short sleep duration has a negative relationship with muscle mass decline in a community-dwelling, elderly Chinese population. more...

Currently, the 2019 novel coronavirus(2019-nCoV) has caused a worldwide emergency because of its long period of incubation and high infectivity. As the first country where the severity of the disease has been witnessed, China has been implementing some effective policies to prevent the spread of the infection. For example, all citizens, who come back to the community from other cities, other provinces, or other countries, have to be obligatorily isolated until they were affirmed to be uninfected. However, there was someone who concealed the travel experiences in the health survey, and they had infected many healthy people before testing positive for Coronavirus. Therefore, in this paper, an IoT system, which is composed of the wearable healthcare device, the smartphone, and the cloud servers, is described. It aims to give support for the management of communities to distinguish the people having close contact with the confirmed cases. Hence, basic health monitoring sensors are employed by the wearable device, and this device will be cheaper than the common wearable products, such as Mi Band or iWatch, because it only has the basic functions. Furthermore, the device can communicate with the smartphone of users via Bluetooth Low Energy to send messages about health conditions or receive simple commands. Moreover, through the techniques of the internet, the phone can convey the vital signals and the present locations of users, which are obtained by special locating systems, to the cloud server. The cloud server processes and records the data, and an application on the smartphone can provide the visualized results of cloud computing to users. more...

Objective The objective of this study was to examine the incidence of new onset depressive symptoms and associated factors over a 1-year period in an older Chinese suburban population. Design Prospective cohort study. Setting and Participants The sample comprised 691 Chinese community-dwelling participants (304 men; mean age 67.5 ± 5.7 years) without depressive symptoms at baseline, recruited from Chadian of Tianjin, China. Measures We had documented detailed information regarding sociodemographics, behavioral characteristics, and medical conditions. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) criteria. The outcome was new onset depressive symptoms at 1-year follow-up, defined as a score of ≥11 on the 30-item Geriatric Depression Scale. Results We found that 83 (12.0%) of the 691 participants without depressive symptoms at baseline had developed depressive symptoms. After multivariate adjustments, it was found that the incidence of new onset depressive symptoms was associated with sarcopenia, type 2 diabetes mellitus, and cardiovascular disease. People with a higher level of muscle mass and better sleep quality were significantly less likely to develop depressive symptoms than their counterparts. Conclusions/Implications We found that the incidence of depressive symptoms increased with some chronic diseases, such as sarcopenia, type 2 diabetes mellitus, and cardiovascular disease. In addition, muscle mass was the most related protective factor among sarcopenia's 3 basic diagnosis components—muscle mass, muscle strength, and physical performance. Hence, maintaining enough muscle mass could be beneficial in the prevention of depressive symptoms for older adults. more...

The objective of this study was to determine falls risk profiles to derive a falls risk prediction score and establish a simple and practical clinical screening tool for Chinese community-dwelling elderly individuals. This was a prospective cohort study (n = 619) among adults aged 60 years and older. Falls were ascertained at a 1-year follow-up appointment. Sociodemographic information, medical history, and physical performance data were collected. The mean age was 67.4 years; 57.7% were women. Female sex (odds ratios [ORs] 1.82; 95% confidence interval [95% CI] 1.17-2.82), diabetes (OR 2.13; 95% CI 1.13-3.98), a Timed Up and Go Test (TUGT) ≥10.49 seconds (OR 1.51; 95% CI 1.23-1.94), a history of falls (OR 3.15; 95% CI 1.72-5.79), and depression (Geriatric Depression Scale [GDS] ≥11, OR 2.51; 95% CI 1.36-4.63) were the strongest predictors. These predictors were used to establish a risk score. The area under the curve of the score was 0.748. From a clinical point of view, the most appropriate cutoff value was 7 (97.5% specificity, 70.7% positive predictive value, and 83.6% negative predictive value). For this cutoff, the fraction correctly classified was 82.5%. A cutoff score of 7 derived from a risk assessment tool using four risk factors (gender, falls history, diabetes, and depression) and the TUGT may be used in Chinese community-dwelling elderly individuals as an initial step to screen those at low risk for falls. more...

BACKGROUND The aim of the present study was to examine the risk factors for developing diabetes after 3 years in an elderly Chinese suburban population with impaired fasting glucose (IFG). METHODS The study population comprised residents of the Hangu area of Tianjin, China, with IFG, aged ≥60 years, who joined the national free physical examination program (n = 328; mean [±SD] age 68.0 ±6.1 years; 48.2% men). Diabetes was defined by self-report of a physician's diagnosis or fasting plasma glucose (FPG) ≥7.0 mmol/L; IFG was defined as FPG ≥5.6 and more...

Li Kang,1,2 Peipei Han,2 Jiazhong Wang,2 Yixuan Ma,2 Liye Jia,2 Liyuan Fu,2 Hairui Yu,2 Xiaoyu Chen,2 Kaijun Niu,3,4 Qi Guo1,2 1Department of Rehabilitation Medicine, Tianjin Economic-Technological Development Area International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, 2Department of Rehabilitation Medicine, 3Nutritional Epidemiology Institute, 4School of Public Health, Tianjin Medical University, Tianjin, China Purpose: Falling is a major health problem in community-dwelling elderly individuals. The aim of the present study was to conduct a prospective investigation to evaluate the accuracy of the Timed Up and Go Test (TUGT), 4-meter walking test, and grip strength test to screen for the risk of falls and to determine a cutoff point to be used clinically.Patients and methods: This was a prospective study that included 541 participants. The fall data were obtained via face-to-face interview, and the date, site, and circumstances of any falls were recorded. TUGTs were recorded as part of a comprehensive geriatric assessment. We collected the same data at baseline and after follow-up via comprehensive geriatric assessment.Results: The incidence of falls of our study subjects was 20.8%. The recurrent-fall group had a fall rate of 6.8% during the follow-up year. The standard area under the curve (AUC) of our screening tool was >0.70, and hence our tool can be used for clinical purposes. After adjusting for age and gender, the AUC of TUGT became 0.642, so it cannot be used as a predictive tool for measuring any types of falls. However, when recurrent falls were adjusted for age and gender, the TUGT’s AUC improved to 0.733 and a score of 15.96 seconds is used as a cut-point to screen recurrent falls in community-dwelling elderly Chinese individuals.Conclusion: Future falls were best predicted by TUGT in recurrent fallers at baseline. A score of 15.96 seconds is used as a cut-point to screen recurrent falls in community-dwelling elderly Chinese individuals. Keywords: community dwelling, elderly, fall, TUGT more...

Background: Reduced muscle strength, as measured by handgrip strength (HS), has been associated with an increased risk of cardiovascular disease (CVD). The aim of this study was to examine the association between different HS indexes and CVD risk factors in elderly Chinese individuals. We also determine optimal cutoffs of HS indexes for predicting CVD risk factors. Methods: Data were obtained from 603 men and 789 women aged ≥60 years (average age 66.8 ± 6.4 y). These study participants were recruited in the suburb area of Tianjin, China. An individual was considered a patient when they exhibited any one of three CVD risk factors: diabetes mellitus, hypertension and dyslipidemia. All participants were interviewed face-to-face. In addition, serum samples were collected from all participants, and all participants underwent measures of anthropometry and HS. Results: The optimal cutoffs were 0.376 of HS/weight in men and 0.726 of HS/body fat mass in women for predicting diabetes mellitus. The adjusted odds ratios (ORs) of at least one CVD risk factor for those with low muscle strength identified by HS/body fat mass were 2.14 (95% confidence interval [CI]: 1.53, 3.44; p more...

The aim of the present study was to examine the risk factors for developing diabetes after 3 years in an elderly Chinese suburban population with impaired fasting glucose (IFG).The study population comprised residents of the Hangu area of Tianjin, China, with IFG, aged ≥60 years, who joined the national free physical examination program (n = 328; mean [±SD] age 68.0 ±6.1 years; 48.2% men). Diabetes was defined by self-report of a physician's diagnosis or fasting plasma glucose (FPG) ≥7.0 mmol/L; IFG was defined as FPG ≥5.6 and 7.0 mmol/L. Risk factors of incident diabetes at the 3-year follow-up were analyzed individually using logistic regression analysis.Between baseline and the 3-year follow-up, 56 subjects with IFG at baseline had developed diabetes. After multivariate adjustment for demographic and clinical factors, the incidence of diabetes increased with higher FPG (odds ratio [OR] 9.30, 95% confidence interval [CI] 2.84-30.48), but decreased with the grip strength/weight ratio (OR 0.88, 95% CI 0.82-0.94). Moreover, the combination of higher FPG and lower grip strength/weight was associated with a higher incidence of diabetes than higher FPG only or lower grip strength/weight (P 0.05).The present study indicates that higher FPG and lower muscle strength are associated with glycemic deterioration among subjects with IFG after 3 years. The results suggest that not only glucose levels, but also physical performance may be useful markers of the risk of diabetes in this population. more...

Even though stroke is the third, not the first, most common cause of disability-adjusted life years in developed countries, it is one of the most expensive to treat. Part of the expense is due to secondary problems in the post-stroke period including: cognition, memory, attention span, pain, sensation loss, psychological issues, and problems with mobility and balance. Research has identified that exercise has both positive physical and psychosocial effects for post-stroke patients. Therefore, this scientific statement provides an overview on exercise rehabilitation for post-stroke patients.We will use systematic literature reviews, clinical and epidemiology reports, published morbidity and mortality studies, clinical and public health guidelines, patient files, and authoritative statements to support this overview.Evidence clearly supports the use of various kinds of exercise training (e.g., aerobic, strength, flexibility, neuromuscular, and traditional Chinese exercise) for stroke survivors. Aerobic exercise, the main form of cardiac rehabilitation, may play an important role in improving aerobic fitness, cardiovascular fitness, cognitive abilities, walking speed and endurance, balance, quality of life, mobility, and other health outcomes among stroke patients. Strength exercise, included in national stroke guidelines and recommended for general health promotion for stroke survivors, can lead to improvements in functionality, psychosocial aspects, and quality of life for post-stroke patients. Flexibility exercises can relieve muscle spasticity problems, improve motor function, range of motion, and prevent contractures. Stretching exercises can also prevent joint contractures, muscle shortening, decrease spasticity, reduce joint stiffness and improve a post-stroke patient's overall function. Neuromuscular exercises can improve activities of daily living (ADL) through coordination and balance activities. Traditional Chinese exercises are used to improve walking and balance ability as well as increase muscle strength, which is important for post-stroke patients.The present evidence strongly supports the power of exercise for post-stroke patients, which in this study combined aerobic exercises, strength training, flexibility exercises, neuromuscular exercises, and traditional Chinese exercises. This research can encourage post-stroke survivors to consider the importance of exercise in the rehabilitation process. more...

The aim of the present study is to investigate the relationship between sarcopenia and cardiovascular risk factors (CVRF) in the Chinese elderly. A total of 1611 elderly individuals aged ≥60 years were enrolled in this study. The well-established CVRF of diabetes, hypertensions, and dyslipidemia were assessed. Sarcopenia was defined according to the recommended algorithm of the Asian Working Group for Sarcopenia (AWGS). Multiple logistic regression analyses and the linear regressions were used to evaluate the components of CVRF and the number of CVRF of elderly patients with sarcopenia. After adjusting for potential confounders, CVRF was associated with a high prevalence of sarcopenia in elderly Chinese populations. Furthermore, diabetes and hypertension, but not dyslipidemia, were found to be significantly associated with sarcopenia. The OR and 95% CI for sarcopenia of the participants with 1, 2, and 3 features of CVRF were 2.27(1.14–4.48), 4.13(1.80–9.46), and 4.90(1.01–23.81), respectively. A linear increase in the prevalence of sarcopenia was found to be associated with the number of CVRF components in the elderly population (P values for the trends more...

This article aims to examine the effect of mobility limitation and obesity on the risk of new incidence of type 2 diabetes mellitus (T2DM) and mortality. The design was a cohort study (n = 1075) among adults aged 60 years and older. Obesity was defined as body-mass index greater than or equal to 28 kg/m2. Mobility limitation was defined as participants scoring in the top 20% on the timed up and go test or in the slowest 20% for the 4-m walking test. The mean age of the study population was 67.4 ± 5.4 years (age range: 60-86 years), and 57.4% were women. Overall, 5.1% of women and 1.9% of men had both obesity and mobility limitations. During 3-year follow-up, the new incidence of T2DM was 2.98% and the adjusted risk of the new incidence of T2DM was progressively greater in obese subjects without mobility limitation, but not greater in the single mobility limitation subjects. The combination of mobility limitation and obesity (odds ratio = 10.3, 95% confidence interval = 2.25-70.13) has a significantly higher risk than obesity only or mobility limitation only. What is more, obesity with mobility limitation could be an independent predictor of 3-year mortality compared with the other subjects. We demonstrated the associations between obesity and mobility limitation and thus the increased risk of developing, with the combination over time, T2DM and mortality. more...

BACKGROUND:Physical performance is an important healthy factor in elder people. Good living habits, which include sleep, can maintain physical strength and physical performance. The aim of the present study was to conduct a cross-sectional study to determine the association between total sleep duration and physical performance. METHODS:Our study population comprised residents of the township central hospital in the suburban of Tianjin, China. We measured muscle strength, walk speed and balance function by grip, 4-m walk test and timed up and go test (TUGT). We divided sleep duration into four groups 8-9h, >9h. RESULTS:A total 898 participants had completed data (392 men and 506 women, mean age 67.71 years). In man, adjusted sleep duration was associated with lower grip in > 9 h group, the mean value (95% CI) was 0.429 (0.409, 0.448), and longer TUGT time was also associated with long sleep duration, 10.46s (9.97 s, 10.95 s). In women, adjusted slower 4-m walk speed present an inverse U-shaped relation with sleep duration, by 0.93 m/s (0.86 m/s, 0.98 m/s), 0.97 m/s (0.96 m/s, 1.00 m/s), 0.97 m/s (0.95 m/s, 0.99 m/s) and 0.92 m/s (0.89 m/s, 0.96 m/s); longer TUGT time were associated with long sleep duration (> 9 h), by 11.23 s (10.70 s, 11.77 s). CONCLUSION:In Chinese community-dwelling elderly, lower muscle strength and lower balance function were associated with long sleep duration in men. Slower walk speed and lower balance function were associated with long sleep duration in women. more...

Even though stroke is the third, not the first, most common cause of disability-adjusted life years in developed countries, it is one of the most expensive to treat. Part of the expense is due to secondary problems in the post-stroke period including: cognition, memory, attention span, pain, sensation loss, psychological issues, and problems with mobility and balance. Research has identified that exercise has both positive physical and psychosocial effects for post-stroke patients. Therefore, this scientific statement provides an overview on exercise rehabilitation for post-stroke patients. more...

Background Assessment of the association of muscle strength and muscle mass with osteoporosis (OP) is of special interest as muscles are a potential target for interventions (i.e., strength training). Methods A cross-sectional descriptive study encompassing people aged ≥ 60 years (average age: 66.9 ± 6.2 years; men, n = 516; women, n = 652) in the Hangu area of Tianjin, China. The study populations were invited to participate in a comprehensive geriatric assessment. OS was identified by measuring the calcaneal using a quantitative ultrasound and a T score of less than –2.5. Muscle characteristics included grip strength and appendicular skeletal muscle mass (ASM). Results The prevalence of OS in this study was 61.6% (male 52.1%, female 69.1%). Grip strength was negatively related to OS and after adjusting for all other variables, higher grip strength was found to be associated with a lower OS risk (p = 0.023). ASM/height2 was not associated with OS (p = 0.205). Conclusion Based on our study, muscle strength rather than muscle mass is negatively associated with OS in older people; thus, we should pay more attention to muscle strength training in the early stage of the OS. more...

Background More efficient clinical indexes are needed to identify older people most likely to present mobility impairments. The aim of the present study was to determine which handgrip strength (HS) indexes are clinically relevant to detect risk of mobility limitation in the elderly adults. In addition, we attempted to determine an optimal cutoff point for the most relevant index. Methods Data are from 469 men and 609 women aged 60 years and older recruited in the Hangu area of Tianjin, China. Participants scoring in the top 20% on the Timed Up and Go Test or in the slowest 20% for the 4-m walk test were defined as having mobility limitation. Results The prevalence of mobility limitation was 27.6% in women and 24.5% in men. The area under the receiver-operating characteristic curve for HS/body fat mass was 0.723 (95% confidence interval [CI] = 0.658-0.788) in men and for HS/weight was 0.684 (95% CI = 0.628-0.739) in women. These values were indicated higher levels of mobility limitation compared with HS and other relative HS indexes. The cutoffs of the most relevant index in men and women that effectively identified individuals at risk of mobility limitation were 1.884 and 0.281, respectively. Conclusion HS/body fat mass and HS/weight appear to be the indices best associated with mobility limitation for men and women, respectively. Optimal cutoffs for clinically relevant index have the potential to identify elderly adults at risk of mobility limitation. more...