Search Results (13,554)

Background/Objectives: This 12-week randomized controlled trial investigated whether progressive resistance training combined with vitamin D supplementation produces enhanced combined improvements in cardiometabolic profiles and functional capacities compared with monotherapies in elderly Korean women with type 2 diabetes mellitus (T2DM) and vitamin D deficiency. Methods: In a 2 × 2 factorial design, 52 women (aged 65–80 years) with T2DM and serum 25(OH)D < 20 ng/mL were assigned to four groups: Exercise + Vitamin D (Ex + VitD, n = 15), Exercise + Placebo (Ex + Placebo, n = 13), Vitamin D only (VitD, n = 11), or Control (n = 13). Exercise groups completed supervised progressive resistance training three times weekly, and vitamin D groups received 2000 IU/day cholecalciferol. Results: The Ex + VitD group achieved significant improvements in HbA1c (−0.13%, p = 0.019), fasting glucose (−0.79 mmol/L, p < 0.001), insulin (−1.96 μU/mL, p = 0.050), and HOMA-IR (−0.77, p = 0.020). Serum 25(OH)D increased substantially (+15.57 ng/mL, p < 0.001). Calcitonin rose exclusively in the Ex + VitD group (+2.57 pg/mL, p < 0.001, d = 3.34), while monotherapies showed no change. Total cholesterol (−23.93 mg/dL), triglycerides (−25.07 mg/dL), and LDL-cholesterol (−10.20 mg/dL) decreased significantly. Both exercise groups showed marked strength gains (chair stand +8.33 to +10.00 repetitions, p < 0.001) and balance improvements (functional reach +2.47 to +4.46 cm, p ≤ 0.033). Conclusions: Twelve weeks of progressive resistance training combined with vitamin D supplementation produced enhanced combined improvements in glycemic control, insulin sensitivity, calcitonin secretion, muscular strength, and lipid metabolism in elderly women with T2DM and vitamin D deficiency, targeting complementary pathways that neither intervention engaged alone. Full article

As global aging accelerates, identifying age- and lifestyle-associated gut microbiota alterations has become critical for understanding healthy aging and microbiota-targeted interventions. To explore the associations of age and lifestyle factors with gut microbiota profiles in community-dwelling adults, 159 Chongqing residents were divided into young (18–39, n = 44), middle-aged (40–59, n = 71) and elderly (60–89, n = 44) groups. Fecal samples were analyzed by 16S rRNA gene sequencing, and lifestyle factors were assessed using a study-specific structured questionnaire. The Shannon index differed significantly between the young and middle-aged groups (p < 0.05), whereas other α-diversity and β-diversity analyses showed no significant differences. Age-related shift trends included decreased Bacillota and increased abundance of Bacteroidota. Young adults were enriched in Parasutterella, the [Eubacterium] ventriosum group and Anaerostipes; middle-aged adults were enriched in Clostridium sensu stricto 4, Clostridium sensu stricto 1 and Holdemanella; and elderly adults were enriched in Prevotellaceae UCG-004, Helicobacter, Lactobacillus, Streptococcus and Fusobacterium. Lifestyle factors were independently associated with specific microbial signatures, including tea-related enrichment of Catenibacterium and Escherichia–Shigella, exercise-related enrichment of Dialister and Bavariicoccus, and milk-related enrichment of Bacillus and Klebsiella (formerly Raoultella). Overall, these findings provide population-based evidence linking age and lifestyle factors with gut microbial profiles and may inform microbiota-targeted strategies for healthy aging. Full article

Background and Objectives: Urinary tract infections are common in clinical practice, but in hospital settings, especially among older and catheterized patients, the microbial ecology and resistance burden may differ substantially from community-acquired infections. Local surveillance is therefore essential to support appropriate empirical treatment and antimicrobial stewardship. The objective is to describe the microbiological epidemiology of urinary isolates in a tertiary hospital and evaluate temporal trends in antimicrobial resistance among the most frequently isolated microorganisms. Materials and Methods: This retrospective observational study analyzed microbiology laboratory data from Tor Vergata University Hospital, Rome, Italy, collected from January 2022 to June 2025. After WHONET-based deduplication using a 30-day repeat-isolate rule, 5788 deduplicated urinary isolates and 85,888 microorganism–drug associations were included. Descriptive analyses, cumulative antibiograms/antimycograms, and quarterly resistance trends were assessed using univariable and multivariable regression analyses. Results: The population was predominantly elderly, inpatient, and catheter-exposed. Gram-negative organisms predominated, followed by Gram-positive bacteria and fungi. The most frequent isolates were E. coli, K. pneumoniae, E. faecalis, and C. albicans. Although microorganism distribution remained broadly stable over time, resistance increased in several clinically relevant organism–drug combinations, especially among major Enterobacterales. Conclusions: In this high-complexity hospital population, urinary isolates showed a relatively stable microorganism distribution but progressive changes in susceptibility among selected urinary isolates. These findings support setting-specific microbiological surveillance and stewardship-informed empirical treatment strategies. Full article

Background: Insulin resistance (IR) indices—C-reactive protein–triglyceride–glucose index (CTI), triglyceride–glucose (TyG) index, and weight-adjusted waist index (WWI)—are linked to cardiovascular disease (CVD), but their comparative utility in prediabetic populations remains unclear. To evaluate the associations and exploratory mediating roles of CTI, TyG and WWI with prevalent CVD in middle-aged and elderly patients with prediabetes. Methods: The study included 3121 NHANES participants aged ≥45 with prediabetes. Four machine learning algorithms identified key variables. Multivariable logistic regression and restricted cubic spline analyses examined the associations between IR and CVD. Model performance was assessed via receiver operating characteristic curves, net reclassification improvement, integrated discrimination improvement, calibration, and decision curve analysis. Subgroup analyses tested robustness. Mediation analysis assessed the mediating roles of IR in the WWI–CVD relationship. External validation used CHARLS. Results: Individuals in the highest tertiles of TyG, TyG–WWI, and CTI had approximately twofold higher CVD risk (ORs: 1.80–1.97). RCS showed a significant linear increase in CVD risk with higher IR index levels. In fully adjusted models, AUCs improved markedly over baseline: TyG–WWI 0.771 vs. 0.579. Mediation analyses indicated that CTI and TyG mediated 22.13–26.30% of the WWI–CVD association. Subgroup analyses and external validation in CHARLS supported the robustness. Conclusions: IR, as captured by TyG, TyG–WWI, and CTI, independently elevates CVD risk among middle-aged and older adults with prediabetes. WWI is associated with greater odds of prevalent CVD, potentially driven by adiposity accumulation, with CTI and TyG partially mediating this effect. Full article

This study aimed to explore the key factors to consider when developing and sharing open-source assistive technology (AAT). To this end, the sip-and-puff mouse was selected from development requests submitted to the Korean Assistive Technology Open Platform. In this study, the sip-and-puff mouse was developed, applied, and shared as an open-source AAT for individuals with disabilities. The research was conducted based on usability feedback collected from five participants through three usability evaluations. During the usability evaluations, task performance scores and time taken were measured, and questionnaires were completed. Following the second usability evaluation, a diary study on long-term usage was conducted. Descriptive statistics, frequency analysis, and paired t-tests were performed using SPSS 22.0. Thematic analysis was conducted using ATLAS.ti. Based on the integrated qualitative and quantitative findings, practical design directions for user-centered open-source assistive technology were identified, including user and environmental matching, customization, durability, supporting documentation, use-error management, and participatory development. The results of this study are expected to contribute to improving the usability of customized open-source assistive technology (AAT) through a participatory design approach. Highly usable open-source AATs will help to make AATs more widely utilized in the daily living activities of the elderly and people with disabilities. Full article

In natural language understanding, intent recognition plays a central role in human–computer interaction. However, in elderly-care scenarios, acoustic signals are often affected by atypical speech patterns, slower speaking rates, and environmental noise, making audio information less reliable and reducing the effectiveness of conventional text–audio fusion methods. To address this problem, we propose a prompt-guided and quality-aware text–audio intent recognition framework. Specifically, a χ²-based intent prototype soft prompt is introduced to enhance the semantic representation of text. Then, a residual-free text-guided cross-attention module is designed to refine degraded acoustic features using textual semantics as reliable guidance. In addition, a dynamic fusion gate is developed to adjust the contributions of text and audio based on modality reliability and intent-related information. Experiments on the MIntRec dataset with simulated acoustic degradation show that the proposed model achieves 60.90% accuracy, 60.80% weighted F1, and 57.90% macro-F1, outperforming several competitive baselines. These results indicate that the proposed framework can improve the robustness of intent recognition under challenging acoustic conditions in elderly-oriented interaction scenarios. Full article

α-Linolenic acid (ALA) is an essential omega-3 polyunsaturated fatty acid, yet how dietary ALA enrichment interacts with population-specific gastrointestinal physiology to dictate bioaccessibility and lipid peroxidation remains insufficiently understood. This study systematically evaluated the in vitro digestive behaviors and oxidation risks of flaxseed oils containing 52% and 68% ALA using simulated models representative of distinct population groups (infants, adults, and the elderly). Digestive efficiency peaked in the adult model, achieving ALA bioaccessibility of 49.2% (52% ALA oil) and 46.5% (68% ALA oil), significantly outperforming those observed in infants (23.1% and 19.5%) and the elderly (39.4% and 37.3%). Crucially, malondialdehyde (MDA) accumulation directly correlated with digestive lipolysis efficiency across population groups, reaching its maximum in adults (5.00 nmol/mL for 52% ALA oil; 7.54 nmol/mL for 68% ALA oil), followed by the elderly (3.06 nmol/mL and 4.02 nmol/mL), and remaining lowest in infants (0.92 nmol/mL and 1.49 nmol/mL). Within each population cohort, although the 68% ALA oil yielded a higher absolute ALA release amount, its relative bioaccessibility was slightly lower while generating elevated MDA levels. These findings demonstrate that increasing ALA concentration imposes a critical trade-off between lipolytic efficiency and oxidative safety across different population groups, providing a solid scientific rationale for designing population-tailored flaxseed oil products optimized for both nutrient delivery and safety. Full article

Diuretics remain indispensable for the treatment of congestion in cardiovascular disease, particularly in acute and chronic heart failure. Their principal clinical value is rapid symptom relief, reduction in filling pressures and facilitation of decongestion; however, a mortality benefit has not been consistently demonstrated. This distinction is clinically important because long-term diuretic exposure in patients without objective congestion may promote hypotension, renal dysfunction, electrolyte instability, neurohormonal activation, falls, cognitive impairment and avoidable polypharmacy. The challenge is therefore not whether diuretics should be used, but how intensively, for how long and under which monitoring strategy. In this narrative review, we summarize the pharmacology of major diuretic classes, the mechanisms of diuretic resistance, and the clinical consequences of potassium, sodium and magnesium disorders. We also discuss drug interactions, frailty, chronic kidney disease, pregnancy, heart failure with preserved ejection fraction and the emerging role of sodium–glucose cotransporter 2 inhibitors and adjunctive proximal-tubule strategies. A practical approach is proposed: use loop diuretics promptly when congestion is present, reassess response with symptoms, weight, urine output, renal function, electrolytes and congestion markers, and reduce or discontinue therapy once euvolemia is achieved and maintained. Deprescribing should be individualized, gradual and reversible, with explicit thresholds for restarting treatment. Optimized diuretic care requires the same discipline applied to disease-modifying heart failure therapy: phenotype recognition, dose minimization, close follow-up and avoidance of treatment inertia. Full article

This article describes a new hardware/software alert system designed to assist elderly people and prevent falls due to bed-exit events at night. To assist the elderly during the night, it is important to implement automatic lighting activation in the bedroom. This helps reduce the risk of falls when they need to, for example, go to the bathroom. The caregiver can be alerted immediately via Wi-Fi, during the night, providing immediate assistance to the elderly person. The developed HW/SW system combines a passive infrared motion sensing device, a light sensor, and dedicated hardware based on the ESP32-C6 RISC-V microcontroller that communicates via Wi-Fi with a developed Android dedicated App, which the caregiver can access using a tablet or smartphone. Nighttime falls remain one of the most serious health problems for older people. The main innovative contribution of this work is the development of a low-cost preventive battery-free assistive system that does not require an internet access contract, preserves the elderly person’s privacy, and promptly alerts the caregiver whenever the elderly person gets out of bed during the night. The system is directly integrated with automated lighting, preventing the elderly person from walking in the dark and without appropriate aid. The system also supports the caregiver by generating alerts through an open-source mobile App. Full article

Background: Elderly patients with type 2 diabetes mellitus (T2DM) often experience cognitive decline and physical function degradation. However, whether cognitive function mediates the association between T2DM and physical performance in older adults has not been previously examined. This study aimed to explore whether cognitive function was statistically associated with the relationship between T2DM and physical performance in older adults using mediation analysis. Methods: We conducted a cross-sectional study, and a total of 102 participants aged ≥60 were included (46 patients with T2DM and 56 non-diabetes controls). Cognition was assessed using standardized neuropsychological tests (global cognition, as assessed by the MoCA total score; and domain-specific measures). Physical performance was quantified by walking speed and handgrip strength. Mediation analyses were performed to test whether the cognitive function statistically accounted for part of the association between the T2DM state and the physical performance. Results: Participants with T2DM had poorer cognitive performance and lower physical performance than controls. In mediation models, the MoCA total score statistically accounted for approximately 18% of the association between T2DM and gait speed (ACME −5.19 cm/s, 95% CI −8.73 to −2.32; proportion mediated 0.18, 95% CI 0.08–0.32). For grip strength, the corresponding proportion was estimated at 60% (ACME −2.16 kg, 95% CI −3.78 to −0.81; proportion mediated 0.60, 95% CI 0.23–1.81), although this estimate should be interpreted cautiously because of the wide confidence interval. Conclusions: This study suggests that poorer cognitive performance may partially account for the observed relationship between T2DM and the decline in physical performance of the elderly. The results support the presence of concurrent cognitive and physical impairment among older adults with T2DM. Given the cross-sectional design, these findings should be regarded as exploratory and hypothesis-generating, and longitudinal studies are required to establish temporal relationships. Full article

The global shift toward clean and low-carbon household energy is central to achieving the Sustainable Development Goals and improving welfare in developing countries, yet it also raises distributional concerns about who benefits and who is left behind. Using five rounds of data from the China Family Panel Studies (CFPS) spanning 2014–2022, this study employs a two-way fixed-effects model with province and year dummies and the Bootstrap method to examine the association between cooking energy transition and rural household development resilience. The results show that the share of traditional solid fuels (fuelwood and coal) declined from 56.29% in 2014 to 36.56% in 2022, while the share of fossil gas rose from 22.26% to 39.91%, indicating a transitional stage in rural cooking energy use. Cooking energy transition is positively associated with rural household development resilience. Household education and farmers’ digital literacy are positively associated with both cooking energy transition and household development resilience, suggesting they may be relevant channels. The association is more pronounced among households with a low elderly dependency ratio, poor infrastructure accessibility, and adequate energy affordability, underscoring that the benefits of energy transition are not evenly distributed. These findings highlight the importance of inclusive and differentiated energy policies for ensuring that the gains from clean cooking reach the most vulnerable rural households. Full article

As rapid population aging coincides with intensifying urban heat island (UHI) effects, ensuring the outdoor thermal comfort of the elderly in hot–humid regions has become a critical challenge. This study investigates the influence of residential spatial morphology and wind environment on elderly thermal comfort in Fuzhou, China, by integrating PHOENICS and RayMan numerical simulations with a multivariate statistical framework. The Physiological Equivalent Temperature (PET) was calculated across three metabolic intensities (sedentary, walking, and exercising), while the LMG algorithm was used in R to identify the driving mechanisms. Residential layouts are stratified into High-Performance (Group A) and High-Risk (Group B) categories based on their thermal risk. In Group A, the microclimate is convective-dominant wind speed and air changes per hour are the primary determinants of thermal comfort. Conversely, Group B exhibits a radiation-dominant mechanism, with the sky view factor acting as the primary driver of heat stress in confined environments. Furthermore, metabolic intensity emerges as a decisive factor, as physical exercise frequently pushes PET beyond the 37.1 °C threshold even in high-performance layouts. Accordingly, this study proposes differentiated strategies: prioritizing ventilation-led optimization for Group A and radiation-shielding interventions for Group B, while advocating for supplementary active cooling in high-intensity activity zones to safeguard the geriatric population during peak summer heat. Full article

Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is an uncommon but likely underrecognized degenerative retinal disorder characterized by peripheral subretinal and sub-retinal pigment epithelium hemorrhagic and exudative lesions, predominantly affecting elderly individuals. The condition frequently mimics choroidal melanoma and other peripheral retinal diseases, often resulting in diagnostic uncertainty and occasionally unnecessary invasive procedures. Recent advances in multimodal imaging have substantially improved the recognition and characterization of PEHCR, suggesting possible associations with polypoidal choroidal vasculopathy and the pachychoroid disease spectrum. A narrative literature review was performed using PubMed/MEDLINE, Scopus, Embase, and Web of Science. Original studies, retrospective case series, multimodal imaging reports, and relevant review articles published in English were included according to their relevance to PEHCR epidemiology, imaging, pathogenesis, differential diagnosis, and treatment. Particular attention was devoted to recent developments in ultra-widefield imaging, optical coherence tomography, indocyanine green angiography, and optical coherence tomography angiography. PEHCR typically presents with peripheral subretinal hemorrhage, exudation, pigment epithelial detachments, and occasionally vitreous hemorrhage. Multimodal imaging, particularly ultra-widefield imaging and ICGA, has substantially improved the diagnosis of PEHCR and supports its relationship with the pachychoroid-PCV spectrum. Although many patients can be managed conservatively, individualized treatment based on lesion activity remains essential, while prospective studies are needed to establish evidence-based management strategies. Full article

Background: While acute coronavirus disease 2019 (COVID-19) infections of the oral cavity, with clinical signs such as taste loss, dry mouth, and mucosal lesions, are well-established health problems, involvement of the oral cavity as a sign of long COVID is poorly understood. One of the organs in the oral cavity that is prone to the virus is the salivary gland. Case presentation: We describe the case of an elderly patient with severe generalized xerostomia and left-sided facial swelling involving the submandibular gland, an uncommon presentation, as the parotid gland is typically involved COVID-19 infections. Ultrasound demonstrated marked ductal dilation without glandular tissue changes. The absence of other causes of sialodochitis, together with a history of repeated COVID-19 infections, led to the diagnosis of post-COVID sialodochitis. Management options were limited by the patient’s frailty and polypharmacy. Nevertheless, conservative symptomatic treatment led to clinical recovery, with no evidence of progression to bacterial or necrotizing sialadenitis. Conclusions: This case demonstrates that COVID-19 infection and its history should be included in the differential diagnosis of sialadenitis. Along with the clinical case presentation, a narrative review of similar studies on COVID-19-associated salivary gland disease was conducted, spanning molecular and post-mortem evidence, acute clinical cases, and post-COVID sequelae. Full article

Background: Single-access transfemoral transcatheter aortic valve implantation (TAVI) reduces the need for multiple vascular access and therefore, the related risk of related complications. However, the impact of patient age on its clinical outcomes remains uncertain. Methods: This is a secondary analysis of previously reported propensity score matched study comparing clinical outcomes of single- versus dual-access transfemoral TAVI using SAPIEN-3-Ultra. We examined the relation between patient age, access strategy and outcomes—specifically, 30-day safety endpoint according to the Valve Academic Research Consortium 3 (VARC-3) and major adverse cardiovascular events (MACE), defined as death, permanent pacemaker, neurological or vascular complications—using logistic regression interaction analyses, and restricted cubic spline modelling. Results: A total of 204 patients (propensity score-matched cohort) were included in the study. The elderly group were more likely to have hypertension, peripheral vascular disease or stroke. The use of single access was comparable. The elderly cohort demonstrated a tendency toward longer fluoroscopy and procedural times compared with the non-elderly group. This pattern likely reflects the greater technical complexity and heightened procedural caution often associated with older patients, including more challenging vascular anatomy and the need for careful device handling. Although not statistically significant, these findings remain clinically meaningful and are consistent with the notion that procedures in elderly patients frequently require more meticulous planning and execution. There was a significant interaction between access strategy and age in reducing MACE, but not in VARC-3 safety outcomes. Single access was associated with a significant reduction in MACE (5.4% vs. 26.7%, p = 0.015) with comparable technical and safety outcomes when compared with elderly patients who underwent dual-access TAVI. Conclusions: Single-access TAVI was linked to favourable early outcomes, maintained procedural success, and suggested a possible age-dependent pattern in the occurrence of MACE. Our findings support the need for randomised studies to demonstrate superiority of single- versus dual-access TAVI, particularly in the elderly population. Full article