Conventional Risk Research Articles

Cyber risk logics and their implications for cybersecurity

Abstract Cybersecurity in national and international security is frequently discussed in an existential register. However, most cybersecurity activities are normal and routine, including diverse practices of cyber risk management. The intricacies of cyber risk and its connection to security and threat politics have received surprisingly little attention in the cyber politics literature. This article addresses this gap through a twofold theoretical proposition. The first argues that cyber risk in policy and practice inhabits a continuum between ‘classical’ risk and security postures. The second proposes the existence of multiple risk logics, located at different points along this continuum. To illustrate this, we outline two distinct cyber risk logics: ‘risk as potential threats’ and ‘risk as uncertainty’. Through an exploratory case-study of cyber risk policy and guidance in the United Kingdom, we find indications of the simultaneous existence of these risk logics, including in specific organizational contexts. We propose that the ‘risk as potential threats’ logic, in particular, acts as a ‘bridge’ between conventional risk and security. We conclude by discussing how differentiating cyber risk logics facilitates a more finely grained appreciation of cybersecurity policy and practice and provides opportunities for disciplinary engagement with the organizational and institutional politics of cybersecurity and ‘the international’.

Robust, extended goal programming with uncertainty sets: an application to a multi-objective portfolio selection problem leveraging DEA

AbstractThis study presents a two-phase approach of Data Envelopment Analysis (DEA) and Goal Programming (GP) for portfolio selection, representing a pioneering attempt at combining these techniques within the context of portfolio selection. The approach expands on the conventional risk and return framework by incorporating additional financial factors and addressing data uncertainty, which allows for a thorough examination of portfolio outcomes while accommodating investor preferences and conservatism levels. The initial phase employs a super-efficiency DEA model to streamline asset selection by identifying suitable investment candidates based on efficiency scores, setting the stage for subsequent portfolio optimization. The second phase leverages the Extended GP (EGP) framework, which facilitates the comprehensive incorporation of investor preferences to determine the optimal weights of the efficient assets previously identified within the portfolio. Each goal is tailored to reflect specific financial factors spanning both technical and fundamental aspects. To tackle data uncertainty, robust optimization is applied. The research contributes to the robust GP (RGP) literature by analyzing new RGP variants, overcoming limitations of traditional and other uncertain GP models by incorporating uncertainty sets. Robust counterparts of the EGP models are accordingly developed using polyhedral and combined interval and polyhedral uncertainty sets, providing a flexible representation of uncertainty in financial markets. Empirical results, based on real data from the Tehran Stock Exchange comprising 779 assets, demonstrate the superiority of the proposed approach over traditional portfolio selection methods across various uncertainty settings. Additionally, a comprehensive sensitivity analysis investigates the impact of uncertainty levels on the robust EGP models. The proposed framework offers guidance to investors and fund managers through a pragmatic approach, enabling informed and robust portfolio decisions by considering efficiency, uncertainty, and extended financial factors.

Navigating systemic risks: governance of and for systemic risks

Abstract Non-technical summary Systemic risks such as climate change and pandemics are complex and interconnected. Managing such risks requires effective organisational structures and processes. This publication presents conceptually robust, evidence-based approaches for assessing and managing systemic risks. Technical summary Systemic risks originate and evolve in the nexus of tightly coupled dynamic systems, which are a characteristic of modern societies in the Anthropocene. Systemic risk implies the breakdown of a system which provides essential functions to society. Connectivity between systems is a key enabler for systemic risk to manifest through cascading effects. Thus, systemic risks originate and evolve in the nexus of tightly coupled dynamic systems. Cascading effects and the convergence of systemic risks with conventional risks as well as other systemic risks challenge the established modes of risk governance that still rest to a large extent on differentiation and compartmentalisation. Thus, governance of systemic risks requires an integrative approach towards risk governance that combines interdisciplinary risk analysis with iterative, adaptive and inclusive governance procedures. By drawing on the case studies of the COVID-19 pandemic and climate change, this paper proposes an innovative risk governance framework for systemic risks based on the integration of systems analysis and a governance procedure with the salient features of reflection, iteration, inclusion, transparency and accountability. Social media summary Systemic risks highlight the interconnected nature of our contemporary societies which calls for tailored responses.

Experimental Study on the Risk Preference Characteristics of Members in Supply Chain Emergencies

Since risk preference affects the behavior of decision makers, the study of its characteristics and impact on decision-making contributes to good planning for emergency coordination. The consistency of a member’s risk preferences in the conventional risk field and emergencies of a supply chain was analyzed by applying the prospect theory and adapting the domain-specific risk-taking (DOSPERT) scale. The influence of time pressure on the risk preferences and decision-making behaviors of members was studied in the emergency field and its sub-emergencies of a supply chain. The conclusions were drawn based on the empirical study. First, the risk preference could be measured in terms of conventional risk and emergencies. Second, the members tended to be risk averse with no time pressure, and the degree of risk aversion was weakened with time pressure, which had the greatest effect in the natural disaster event. Third, even though the change in risk preference had a consistency regarding the four types of sub-events of supply chain emergencies, it was inconsistent regarding the conventional risks and emergencies. With the evolution trend of risk preference demonstrated and the relationship between preference and time pressure revealed, this study may provide a decision-making reference for the formulation of a supply chain emergency coordination scheme.

Climate transition risk in U.S. loan portfolios: Are all banks the same?

We examine banks' exposure to climate transition risk using a bottom-up, loan-level methodology incorporating climate stress test based on the Merton probability of default model and transition pathways from the Intergovernmental Panel on Climate Change (IPCC). Specifically, we match machine learning predictions of corporate carbon footprints to syndicated loans initiated in 2010–2018 and aggregate these to loan portfolios of the twenty largest banks in the United States. Banks vary in their climate transition risk not only due to their exposure to the energy sectors but also due to borrowers' carbon emission profiles from other sectors. Banks generally lend a minimal amount to coal (0.4%) but hold a considerable exposure in oil and gas (8.6%) and electricity firms (4.6%) and thus have a large exposure to the energy sectors (13.5%). We observe that climate transition risk profile was stable over time, save for a temporary (in some cases) and permanent (in others), reduction in their fossil-fuel exposure after the Paris Agreement. From the stress testing, the median loss is 0.5% of US syndicated loans, representing a decrease in CET1 capital of 4.1% when extrapolated to the whole balance sheet. The loss is twice as large in the 1.5°C scenarios (1.4%–2.1% of loan value, 12%–16% of CET1 capital) compared to the 2°C target (0.6%–1.1% of loan value, 5%–9% of CET1 capital) with significant tail-end risk (7.7% of loan value, 62% of CET1 capital). Banks' vulnerabilities are also driven by the ex-ante financial risk of their borrowers more generally, highlighting that climate risk is not independent from conventional risks.

Preoperative NT-proBNP and LVEF for the prediction of acute kidney injury after noncardiac surgery: a single-centre retrospective study

BackgroundAcute kidney injury (AKI) is one of the most common postoperative complications in noncardiac surgical patients, has an important impact on prognosis and is difficult to predict. Whether preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations and left ventricular ejection fraction (LVEF) levels can predict postoperative AKI in noncardiac surgical patients is unclear.MethodsWe included 3,314 patients who underwent noncardiac surgery and had measurements of preoperative NT-proBNP concentrations and LVEF levels at a tertiary academic hospital in China between 2008 and 2018. Multiple logistic regression analysis was used to construct a postoperative AKI risk prediction model for this cohort. Then, NT-proBNP concentrations and LVEF levels were included in the abovementioned model as independent variables, and the predictive ability of these two models was compared.ResultsPostoperative AKI occurred in 223 (6.72%) patients within 1 week after surgery. Preoperative NT-proBNP concentrations and LVEF levels were independent predictors of AKI after adjustment for clinical variables. The area under the receiver operating characteristic curve (AUROC) of the AKI risk predictive model established with clinical baseline variables was 0.767 (95% CI: 0.732, 0.802). When NT-proBNP concentrations and LVEF levels were added to the base model, the AUROC was 0.811 (95% CI: 0.779, 0.843). The addition of NT-proBNP concentrations and LVEF levels improved reclassification by 22.9% (95% CI 10.5–34.4%) for patients who developed postoperative AKI and by 36.3% (95% CI 29.5–43.9%) for those who did not, resulting in a significant overall improvement in net reclassification (NRI: 0.591, 95% CI 0.437–0.752, P < 0.000). The integral discrimination improvement was 0.100 (95% CI: 0.075, 0.125, P < 0.000).The final postoperative AKI prediction model was constructed, and had a good discriminative ability and fitted to the dataset.ConclusionsPreoperative NT-proBNP concentrations and LVEF levels were independently associated with the risk of AKI after noncardiac surgery, and they could improve the predictive ability of logistic regression models based on conventional clinical risk factors.Trial registrationThe protocol was preregistered in the Chinese Clinical Trial Registry (ChiCTR1900024056).

427-P: Nonalcoholic Fatty Liver Disease and Type 2 Diabetes Are Mutually Independent Predictors of Major Cardiovascular Events in Patients with Established Cardiovascular Disease

Non-Alcoholic Fatty Liver Disease (NAFLD) is associated with insulin resistance, type 2 diabetes (T2DM) and cardiovascular disease. However, data on NAFLD in patients with established cardiovascular disease (CVD) are scarce. Here, we therefore aimed at investigating the association of NAFLD with T2DM as well as its impact on the incidence of major cardiovascular events (MACE) in a large series of 1517 patients with established CVD (1199 patients with angiographically proven coronary artery disease and 318 patients with sonographically proven peripheral artery disease) , using the validated fatty liver index for the diagnosis of NAFLD. At baseline, the prevalence of NAFLD was significantly higher in patients with T2DM than in non-diabetic subjects (61.3% vs. 39.8%; p&amp;lt;0.001) respectively. Prospectively, we recorded 498 MACE over a mean follow-up period of 10.0±4.5 years. The risk of MACE was higher in NAFLD patients than in those who did not have NAFLD (49.5 vs. 43.5%; p=0.020) and in patients with T2DM than in non-diabetic subjects (41.4 vs. 28.1%; p&amp;lt;0.001) . Cox regression models adjusting for conventional cardiovascular risk factors proved NAFLD and T2DM to be mutually independent predictors of MACE, with adjusted hazard ratios of 1.34 [1.06-1.69] p=0.013 and 1.59 [1.32-1.92]; p&amp;lt;0.001, respectively. We conclude that NAFLD and T2DM are mutually independent predictors of MACE in patients with established CVD. Disclosure L.Sprenger: None. M.Maechler: None. A.Vonbank: None. B.Larcher: None. A.Mader: None. A.Leiherer: None. A.Muendlein: None. H.Drexel: None. C.H.Saely: None.

Association of the atherogenic index of plasma with cardiovascular risk beyond the traditional risk factors: a nationwide population-based cohort study

BackgroundThe atherogenic index of plasma (AIP) is composed of triglycerides and high-density lipoprotein cholesterol and is a novel marker for assessing the risk of atherogenicity and cardiometabolic health. An association between AIP and greater frequency of major adverse cardiovascular events (MACEs) in patients with type 2 diabetes mellitus and high cardiovascular (CV) disease risk has been reported. However, only few studies have examined the correlation between AIP and CV risk in general populations. We thus aimed to evaluate the relationship between AIP and CV diseases using a large-scale population dataset from the Korean National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS).MethodsA total of 514,866 participants were enrolled from the NHIS-HEALS and classified according to the AIP quartiles. We performed univariate and multivariate Cox proportional hazards regression analyses to determine the association between AIP and MACEs, CV events, and CV mortality.ResultsDuring follow-up, we documented 12,133, 11,055, and 1942 cases of MACEs, CV events, and CV mortality, respectively. The multivariate-adjusted hazard ratios [HRs; 95% confidence interval (CI)] for MACEs gradually and significantly increased with the AIP quartiles [1.113 (1.054–1.175) in Q2, 1.175 (1.113–1.240) in Q3, and 1.278 (1.209–1.350) in Q4], following an adjustment for the conventional CV risk factors, including age, sex, body mass index, smoking, alcohol drinking, physical activities, household income, fasting glucose, systolic blood pressure, low-density lipoprotein cholesterol, and estimated glomerular filtration rate. In subgroup analyses, the association of AIP with MACEs and CV events was particularly outstanding in patients with diabetes.ConclusionsAIP was significantly associated with CV risks after adjusting for the traditional risk factors. Therefore, it may be used as an effective mass screening method to identify patients at a high risk of CV events.

Various vascular malformations are prevalent in Finnish pseudoxanthoma elasticum (PXE) patients: a national registry study

BackgroundPseudoxanthoma elasticum (PXE, OMIM# 264800) is an inborn error of metabolism causing ectopic soft tissue calcification due to low plasma pyrophosphate concentration. We aimed to assess the prevalence of PXE in Finland and to characterize the Finnish PXE population. A nationwide registry search was performed to identify patients with ICD-10 code Q82.84. Information was gathered from available medical records which were requisitioned from hospitals and health centers. Misdiagnosed patients and patients with insufficient records were excluded.ResultsThe prevalence of PXE in Finland was 1:260,000 with equal sex distribution. Patients with high conventional cardiovascular risk had more visual and vascular complications than patients with low risk. Four patients (19%) had at least one vascular malformation. A high proportion (33%) of ABCC6 genotypes were of the common homozygous c.3421C > T, p.Arg1141Ter variant. Nine other homozygous or compound heterozygous allelic variants were found.ConclusionsThe prevalence of diagnosed PXE appears to be lower in Finland than in estimates from other countries. Decreased visual acuity is the most prevalent complication. We suggest that various vascular malformations may be an unrecognized feature of PXE.

Optimal repetitive reliability inspection of manufactured lots for lifetime models using prior information

Repetitive group inspection of production lots is considered to develop the failure censored plan with minimal expected sampling effort using prior information. Optimal reliability test plans are derived for the family of log-location-scale lifetime distributions, whereas a limited beta distribution is assumed to model the proportion nonconforming, p. A highly efficient and quick step-by-step algorithm is proposed to solve the underlying mixed nonlinear programming problem. Conventional repetitive group plans are often very effective in reducing the average sample number with respect to other inspection schemes, but sample sizes may increase under certain conditions such as high censoring. The inclusion of previous knowledge from past empirical results contributes to drastically reduce the amount of sampling required in life testing. Moreover, the use of expected sampling risks significantly improves the assessment of the actual producer and consumer sampling risks. Several tables and figures are presented to analyse the effect of the available prior evidence about p. The results show that the proposed lot inspection scheme clearly outperforms the standard repetitive group plans obtained under the traditional approach based on conventional risks. Finally, an application to the manufacture of integrated circuits is included for illustrative purposes.

Anti-inflammatory strategies for atherosclerotic artery disease

ABSTRACT Introduction Atherosclerosis is the most frequent cause of coronary artery disease (CAD) and inflammation is a key driver of its pathogenesis. Targeting inflammation represents a novel therapeutic option beyond management of conventional cardiovascular risk factors. Recent efforts in cardiovascular research were aimed at investigating the efficacy and safety of existing and novel anti-inflammatory drugs. Areas covered The multimodal activation of the immune response enables several approaches to mitigate the inflammatory burden of atherosclerosis, which include general cardiovascular preventive measures from healthy lifestyle behaviors to medications with ancillary anti-inflammatory effects, such as lipid-lowering drugs. Clinical development of several specific anti-inflammatory drugs has been halted due to lack of proven efficacy in humans, while a number of trials are ongoing to test drugs targeting the NLRP3-IL1-IL6-hsCRP pathway, including drugs that are already in use for immune disorders (i.e. colchicine). Expert opinion The main challenge associated with specific anti-inflammatory drugs is the risk of immunological suppression. Due to positive results in recent randomized trials and a favorable safety profile, colchicine is expected to gain more popularity in the near future as an anti-inflammatory agent for cardiovascular prevention.

Abstract EP14: Traditional And Non-traditional Cardiometabolic Risk Factors For Type 2 Myocardial Infarction Compared To Type 1 Myocardial Infarction In Young Women (18-44 Years): A National Inpatient Analysis

Background: There has been growing interest in studying demand ischemia as a cause of type 2 myocardial infarction (T2MI) in younger patients. Conventional cardiovascular risk factors and their association (and degree) are vaguely defined as predictors of T2MI. Women may be noted to have different predictors given their underrepresentation in clinical trials. Methods: We analyzed young female (18-44 years) hospitalizations from the National Inpatient Sample 2018 for multivariate-adjusted predictors (aOR, 95% confidence interval) of T2MI, STEMI and NSTEMI admissions, and divided the significance level into p&lt;0.01, p&lt;0.05 &amp; p&lt;0.1. Results: Young females (n=6,152,028) had 0.05% STEMI, 0.16% NSTEMI and 0.08% T2MI admissions. Predictors (Table 1) with the highest significance level of association for T2MI (p&lt;0.01), compared to ST/NSTEMI (either 0.01&lt;p&lt;0.05 or not significant), were black race (aOR 1.49) and CHF (aOR 1.97), pulmonary circulation disorder (aOR 1.83) and OSA (aOR 1.62). Valvular heart disease, paralysis, COPD, deficiency anemia predicted a higher risk of T2MI admissions in young women (p&lt;0.05) but not STEMI/NSTEMI admissions. Hypertension, prior MI, dyslipidemia, family history of coronary artery disease, peripheral vascular disease, coagulopathy and fluid-electrolyte disorder predicted a higher risk of T2MI or STEMI/NSTEMI. Collagen vascular disorders and obesity had a higher risk of T2MI/NSTEMI (p&lt;0.01) but not of STEMI (p=0.07). DM, and cocaine abuse predicted higher odds of STEMI/NSTEMI but not of T2MI. Hypothyroid, liver disease, metastatic cancer, AIDS, depression, alcohol abuse and cannabis abuse did not predict a higher risk of T2MI or STEMI/NSTEMI. Hypothyroid, liver disease, metastatic cancer, AIDS, depression, alcohol and cannabis abuse did not predict higher odds of T2MI or STEMI/NSTEMI in young women. Conclusion: Predictors associated with T2MI in young females with a higher order of significance than ST/NSTEMI can be utilized to build a risk score for T2MI in young females.

Abstract EP53: The Association Of Oral Hypofunction/locomotive Syndrome And Increased Arterial Stiffness

Background: Frailty is associated with higher risk of cardiovascular disease (CVD). Recently, oral hypofunction, a disease in which the oral function is complexly reduced not only by ageing but also by a variety of factors, is regarded as a risk factor for frailty. Also, locomotive syndrome, which is defined as reduced mobility due to impaired locomotive organs, is reported to have close association with frailty and oral hypofunction. However, no studies evaluated the association of oral hypofunction / locomotive syndrome and arterial stiffness, a marker of CVD. The objective of this study is to evaluate the association of oral hypofunction / locomotive syndrome and arterial stiffness. Hypothesis: We hypothesized that subjects with oral hypofunction or locomotive syndrome have increased arterial stiffness compared to those without oral hypofunction and locomotive syndrome. Methods: Japanese Subjects above 50 years old who underwent annual health-checkup were enrolled in this cross-sectional study. Subjects with history of CVD and dementia were excluded. Arterial stiffness was evaluated by brachial-ankle pulse wave velocity (baPWV). Oral hypofunction was evaluated the methods based on the guidance by the Japanese Association for Dental Science. Seven oral factors, oral hygiene, oral moisture, occlusal force, tongue-lip motor function, tongue pressure, masticatory function, and swallowing function were assessed. Oral hypofunction was diagnosed if more than 3 factors showed deterioration. Locomotive syndrome was evaluated by the questionnaires (GLFS-25) and physical performance tests consisted of those for quadriceps muscle strength, a two-step test, and a stand-up test according to the guidance by the Japanese Orthopedic Association. The association of oral hypofunction / locomotive syndrome and baPWV was assessed by multivariable linear regression analysis adjusted for conventional CVD risk factors. Results: Among 148 subjects (mean age: 59±7 years), 82 subjects (55%) had either oral hypofunction or locomotive syndrome (oral hypofunction: 33 subjects, locomotive syndrome: 65 subjects). BaPWV in subjects with either oral hypofunction or locomotive syndrome was significantly higher than subjects with none of them (mean baPWV: 1501±292 v.s. 1368±238cm/sec, p=0.003). Multivariable linear regression analysis revealed that the existence of either oral hypofunction or locomotive syndrome was significantly associated with increased arterial stiffness (β=100±39, p=0.01). Conclusion: The existence of either oral hypofunction or locomotive syndrome was associated with increased arterial stiffness. Further research on oral hypofunction / locomotive syndrome and CVD is warranted.

New Tricks and Old Dogs: Will the Addition of Venetoclax to Conventional Multidrug Chemotherapy Decrease Relapse Risk for Younger Adults With Newly Diagnosed AML?

New Tricks and Old Dogs: Will the Addition of Venetoclax to Conventional Multidrug Chemotherapy Decrease Relapse Risk for Younger Adults With Newly Diagnosed AML?

Rheumatoid arthritis, as a clinical disease, but not rheumatoid arthritis-associated autoimmunity, is linked to cardiovascular events

BackgroundRheumatoid arthritis (RA) is characterized by increased cardiovascular (CV) mortality. CV events are particularly high in patients with RA-specific autoimmunity, including rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA), raising the question whether RA-specific autoimmunity itself is associated with CV events.MethodsNew CV events (myocardial infarction, stroke or death by CV cause) were recorded in 20,625 subjects of the Electricité de France – Gaz de France (GAZEL) cohort. Self-reported RA cases in the GAZEL cohort were validated by phone interview on the basis of a specific questionnaire. In 1618 subjects, in whom plasma was available, RF and ACPA were measured. A piecewise exponential Poisson regression was used to analyze the association of CV events with presence of RA as well as RA-specific autoimmunity (without RA).ResultsCV events in GAZEL were associated with age, male sex, smoking, hypertension, hyperlipidemia, and diabetes mellitus (HR from 1.06 to 1.87, p < 0.05). Forty-two confirmed RA cases were identified. Confirmed RA was significantly associated with CV risk increase (HR of 3.03; 95% CI: 1.13–8.11, p = 0.03) independently of conventional CV risk factors. One hundred seventy-eight subjects showed RF or ACPA positivity without presence of RA. CV events were not associated with ACPA positivity (HR: 1.52, 95% CI: 0.47–4.84, p = 0.48) or RF positivity (HR: 1.15, 95% CI: 0.55–2.40, p = 0.70) in the absence of RA.ConclusionsRA, as a clinical chronic inflammatory disease, but not mere positivity for RF or ACPA in the absence of clinical disease is associated with increased CV risk.

Single nucleotide substitutions in the matrix metalloproteinase 9 gene in hypertensive individuals of European and South Asian ethnicity in the Far Eastern Federal District

Aim. To determine the association of single nucleotide polymorphism (SNP) -1562C&gt;T (rs3918242) in the matrix metalloproteinase 9 (MMP-9) gene in hypertensive (HTN) in individuals of European and South Asian ethnicity of Primorsky Krai and Sakhalin Oblast.Material and methods. The analysis of conventional and additional risk factors for cardiovascular diseases (35 parameters) in 377 people as a part of regional stage of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study (2014-2019), of whom 240 people of European (Slavic) and 137 people of South Asian (Korean, second- and third-generation immigrants) ethnicity. Substitutions in the MMP-9 gene -1562C&gt;T (rs3918242) was identified by real-time polymerase chain reaction using TaqMan technology.Results. Compared to Koreans, the Slavs have a higher blood pressure (p=0,002). There were no significant differences between ethnic groups (p=0,07) in cardiovascular risk levels using the Systematic Coronary Risk Evaluation (SCORE). Significant differences (p=0,003) were determined in cardiovascular risk levels for healthy Koreans and HTN patients. It was shown that among patients with HTN, the pulse wave velocity exceeded the recommended values in 22,2% of Europeans and in 46,6% of Koreans (p=0,003). The number of hypertensive Europeans and minor MMP-9 rs3918242 T allele exceeded 2,6 times the number of healthy persons (odds ratio, 4,7; 95% confidence interval: 1,1 -7,8 (p=0,03)). MMP-9 rs3918242 T allele in Koreans of the Sakhalin Oblast was not associated with HTN (odds ratio, 0,81; 95% confidence interval: 0,12-5,54 (p=0,83)). Moreover, in South Asian population, heterozygous carriers of T allele prevailed, which significantly (p=0,002) differed from Europeans, who, in general, had a homozygous CC genotype.Conclusion. In Far Eastern Federal District, SNPs in the MMP-9 C-1562T gene were found mainly in hypertensive patients of European ethnicity, while in Koreans, a significant relationship between the carriage of minor T allele in this gene and the presence of HTN was not established.

Chronic Kidney Disease of Uncertain Etiology in Sri Lanka: Curing between Medicine and Traditional Culture

Chronic Kidney Disease of unknown origin (CKDu) has appeared across Sri Lanka’s North Central Province (NCP) since the 1990s as an epidemic, unexplained by conventional associated risk factors. During the past few decades, a large number of studies attempted to determine the unknown etiology of CKDu. Despite these investigations, no concrete conclusions were developed, though a number of contradictory hypotheses emerged. The present ethnographic study was carried out in two endemic areas, labelled as “CKDu hotspots”, and illuminates how curing takes place between biomedicine and traditional cultural practices. Our ethnographic study thoroughly scrutinized three decades of lived experience, lay-perceptions and local discourses on CKDu. We used a qualitative study design with a transcendental phenomenological approach and employed a mixture of ethnographic methods. Data collection techniques included participant observation, in-depth interviews, focus group discussions and key informant interviews. Data was analysed by using an interpretive thematic analysis model. Findings revealed that lay people have constructed a popular discourse on CKDu, and we explored their views on the origin, etiology and prevalence of CKDu in their locality over the past few decades. Patients’ narratives revealed that there were currently a number of gaps in service delivery. These were mainly due to distant relationships between healthcare providers and CKDu patients. Lay people in affected communities were marginalized throughout the investigation process to determine the unknown etiology, their involvement marginalized to merely acting as objects for scientific instigation. The affected communities strongly believed that CKDu was a recent phenomenon resulting from the mismanagement of the natural environment due to social and lifestyle changes. These findings highlight local dynamics of healthcare seeking behaviours which demand complementary medicine system, particularly given the number of limitations in the biomedical system. Empirical evidence generated from this study suggests a conceptual shift to an ethno-medical model to address CKDu. Improving cultural competency and communication skills among healthcare providers in public health are crucial in order to apply a “bio-psychosocial perspective” in healthcare delivery system and bridging the gap between hospital and the community.

Potential Novel Serum Metabolic Markers Associated With Progression of Prediabetes to Overt Diabetes in a Chinese Population.

BackgroundIdentifying the metabolite profile of individuals with prediabetes who turned to type 2 diabetes (T2D) may give novel insights into early T2D interception. The purpose of this study was to identify metabolic markers that predict the development of T2D from prediabetes in a Chinese population.MethodsWe used an untargeted metabolomics approach to investigate the associations between serum metabolites and risk of prediabetes who turned to overt T2D (n=153, mean follow up 5 years) in a Chinese population (REACTION study). Results were compared with matched controls who had prediabetes at baseline [age: 56 ± 7 years old, body mass index (BMI): 24.2 ± 2.8 kg/m2] and at a 5-year follow-up [age: 61 ± 7 years old, BMI: 24.5 ± 3.1 kg/m2]. Confounding factors were adjusted and the associations between metabolites and diabetes risk were evaluated with multivariate logistic regression analysis. A 10-fold cross-validation random forest classification (RFC) model was used to select the optimal metabolites panels for predicting the development of diabetes, and to internally validate the discriminatory capability of the selected metabolites beyond conventional clinical risk factors.FindingsMetabolic alterations, including those associated with amino acid and lipid metabolism, were associated with an increased risk of prediabetes progressing to diabetes. The most important metabolites were inosine [odds ratio (OR) = 19.00; 95% confidence interval (CI): 4.23-85.37] and carvacrol (OR = 17.63; 95% CI: 4.98-62.34). Thirteen metabolites were found to improve T2D risk prediction beyond eight conventional T2D risk factors [area under the curve (AUC) was 0.98 for risk factors + metabolites vs 0.72 for risk factors, P < 0.05].InterpretationsUse of the metabolites identified in this study may help determine patients with prediabetes who are at highest risk of progressing to diabetes.

Homocysteine as a potential indicator of endothelial dysfunction and cardiovascular risk in female patients with borderline personality disorder

BackgroundThere is increasing evidence suggesting that patients with Borderline Personality Disorder (BPD) are at greater risk of developing cardiovascular diseases (CVD) compared to the general population. Homocysteine (Hcy) has been discussed as a serum marker for endothelial dysfunction as a mechanism involved in CVD and has been shown to be associated with numerous psychiatric conditions. Pathophysiologically, there seems to be a link between Hcy and psychological stress mediated by abnormal activity of the autonomic nervous system. Accordingly, the present study sought to examine Hcy in BPD and to explore possible associations with clinical parameters.MethodsPlasma Hcy levels as well as conventional cardiovascular risk factors, such as blood pressure, BMI, smoking habits, HbA1c, HDL, LDL, and cholesterol, were examined in 49 young female in-patients diagnosed with BPD and 50 psychologically healthy control subjects matched for age and sex. Assessment of borderline symptom severity, childhood trauma, exposure to chronic stress, and quality of sleep was performed using self-reported questionnaires.ResultsBPD patients showed significantly higher mean plasma Hcy concentrations compared to controls, though below ranges considered pathological. Moreover, Hcy correlated significantly with the severity of childhood trauma, chronic stress, and subjective sleep disturbances. In a regression model BPD diagnosis was found to predict Hcy levels best.ConclusionIn conclusion, young female BPD patients with no history of CVD show higher, though non-pathological, Hcy levels compared to healthy controls. Our findings seem to support the assumption that BPD is associated with increased risk of CVD, and that Hcy could serve as potential marker for risk evaluation of midlife CVD in BPD patients.

Frequency of Metabolic Syndrome in Type 2 Diabetes Mellitus in a Tertiary Care Hospital of Bangladesh

Background: As a well-established risk factor for coronary heart disease, Metabolic Syndrome was already encountered. But the relationship between Metabolic Syndrome and Type 2 Diabetes Mellitus and the independent contribution of Metabolic Syndrome remained unclear. To evaluate the status of metabolic syndrome in the Type 2 diabetic population and for their ability to predict Type 2 Diabetes Mellitus, in parallel with conventional stroke risk factors, this study was planned. Methods: A hospital-based descriptive observational study was conducted in 100 patients with Type 2 Diabetes Mellitus who were selected by consecutive random sampling techniques. Patients were diagnosed through proper history, clinical examination, and necessary investigations. The outcome values were measured in anthropometric measurements, blood pressure, dyslipidemia, and blood glucose. Results: Among 100 patients with Type 2 Diabetes Mellitus, (64%) were females who were housewives (41%) with significant difference (p &lt; 0.001) and Mean± SD was 58±12.24 yrs ranging from 32-85 years. About 30% had a positive family history of Type 2 Diabetes Mellitus and 28% tobacco abuse. Of the total, 31% of patients had high blood pressure, and 28% had low HDL with a significant difference (p&lt;0.001), but 46% had high triglyceride levels, which was not significant. More than half (53.12%) females showed central obesity, while only 16.67% had central obesity among males, and it showed a significant difference (p=0.04) in both sex. There was a high frequency of Metabolic Syndrome in a patient with Type 2 Diabetes Mellitus (68%) with a significant difference, and 48% were female, and 20 % were male. In patients of Metabolic Syndrome, central obesity was found in 36(52.94%) patients where females were predominantly affected 32(88.89%), hypertension found in 28(4118%) patients where male were predominantly affected 16(57.14%) patients, hypertriglyceridemia found in 44(64.70%) patients where a female was predominantly affected 26(59.09%) patients and low HDL found in 22(32.35%) patients where a female was predominantly affected 16(72.73%). Conclusion: The frequency of Metabolic Syndrome was more than double in women (48%). Central obesity and low HDL were significantly more prevalent in women than men, where hypertension was significant in men. So it would be reasonable to conclude that women are more likely to suffer from Metabolic Syndrome from cardiovascular morbidity and mortality.