Cross-sectional Observational Study Research Articles

Hypomagnesaemia among Diabetic Patients with Chronic Kidney Disease: A Cross-sectional Study

Background: The clinical role of magnesium, especially of hypomagnesaemia, in diabetic and chronic kidney disease patients has been underestimated for many years. Objective: To determine the frequency of hypomagnesaemia in diabetic patients with chronic kidney disease and to investigate the relationship of magnesium level with glycemic and renal status. Methodology: This was a cross-sectional observational study performed on 100 diabetic patients with chronic kidney disease, admitted to BIRDEM General Hospital, Dhaka, Bangladesh, excluding patients with history of chronic diarrhea, laxative abuse, diuretic use, alcoholism and those on dialysis. Several socio-demographic and biochemical parameters were analyzed and compared with magnesium level. Results: Frequency of hypomagnesaemia among the study population was 37% (p= 0.009) and the frequency was found to be increasing with increasing stage of chronic kidney disease. Frequency of hypomagnesaemia was more in patients with uncontrolled fasting blood glucose, post meal blood glucose and HbA1c level (p<0.05). Serum magnesium levels positively correlated with serum creatinine levels (Pearson’s correlation coefficient, r=0.428, p=0.001) and inversely correlated with GFR (Pearson’s correlation coefficient, r= -0.275, p= 0.006). Conclusion: The frequency of hypomagnesaemia among diabetic patients with chronic kidney disease is common. So it would be prudent to routinely monitor for hypomagnesaemia in diabetic patients with chronic kidney. Bangladesh Crit Care J September 2024; 12 (2): 132-137

COMPARING STAGES OF DIABETIC RETINOPATHY WITH SYSTEMIC VASCULAR STATUS USING FINGER PHOTOPLETHYSMOGRAPHY.

To evaluate systemic vascular fitness measured by finger photoplethysmography (PPG) in diabetic retinopathy (DR). This was a cross sectional observational study on type-II Diabetes Mellitus patients from October 2020 to May 2021. Data collected include systolic/diastolic blood pressure (BP), visual acuity, HbA1c, and central macular thickness (CMT). DR severity was categorised using the ETDRS classification. PPG signals were acquired using pulse-oximeter modules (OEM-60, Dolphin Medical Inc) measured for 90 seconds at 275Hz sampling rate and 16-bits resolution which records photoplethysmography fitness index (PPGF), vascular-risk prediction index (VRPI) and vascular age (VascA). One-hundred-and-forty-one patients were equally distributed into six DR categories. Mean age was 58.8±9.9 years, with female-to-male ratio of 1.27. There were significant differences in mean systolic (125.5±10.0mmHg, p=0.007) and diastolic-BP (80.0±8.8mmHg), mean HbA1c (7.6±1.9%, p=0.005), median LogMAR (0.3, IQR:0.2-0.5, p<0.001) and CMT (p=0.003) across DR severity. Significant differences were also seen in PPGF (p=0.001), VRPI (p<0.001) and VascA (p=0.001), with poorer values in severe compared to mild/moderate DR. After adjusting for age, BP and HbA1c, PPGF reduces by 3.3% (regression coefficient, b= -3.27, p<0.001), VascA increases by 2.5 years (b=2.54, p=0.002) and VRPI increases by 3.1 (b= 3.08, p<0.001) with every DR worsening. More severe DR were associated with poorer PPG vascular markers.

Association of PD-L1 immunoexpression with tumor grade in colorectal adenocarcinoma

Globally, colorectal cancer (CRC) is the primary cause of cancer-related deaths, and in emerging countries, its prevalence is continuously increasing. With all the advancements in surgery and treatment, the outlook for CRC patients is still not good. Even with the use of standard prognostic markers, there are presently no effective prognostic techniques for colorectal cancer. The long-term survival of many malignancies has been significantly enhanced by immune checkpoint blockades (ICB), suggesting that the immune checkpoint mechanism is crucial in inhibiting tumor-specific immune responses in the tumor microenvironment. By inhibiting T effector cell activity, the "PD-1 (programmed cell death-1)"/PD-L1 (programmed cell death-ligand 1) axis contributes significantly to immune suppression control and allows tumor cells to evade the host's anti-tumor immune surveillance. While early study suggested that immunotherapy was not relevant for patients with colorectal cancer, more recent studies have demonstrated that immunotherapy was beneficial for a certain subset of patients. This suggests that the prognosis prediction of colorectal cancer may benefit from a thorough evaluation of the local immune response. This study set out to assess the association between PD-L1 immunoexpression and tumor grade in CRC. : This was a cross-sectional observational study. Paraffin blocks of total 64 cases were selected from the patients who were diagnosed as adenocarcinoma from resected samples received in the department of pathology at BSMMU from July 2021 to June 2023. Immuno-histochemical staining for PD-L1 was performed using 28-8 clone along with appropriate positive control. In this study, PD-L1 immuno-expression was found in 14(21.9%) out of 64 cases. However, no expression was found in rest of the 50 (78.1%) cases. This study showed association of PD-L1 expression with high grade (Grade-3) tumors. : Evaluation of expression of PD-L1 may emerge as a new marker and target for the immunotherapy of colorectal cancer.

Relationships of dietary habits with prostate cancer risk: results from Mendelian randomization analyses and the National Health and Nutrition Examination Survey.

Background: Prior investigations identified correlations between dietary habits and the risk of prostate cancer (PCa); however, the causative dynamics are unclear. Methods: Utilizing the Mendelian randomization (MR) framework, we investigated the causal links between dietary habits, daily nutrient intakes, and risk of PCa (79 148 cases and 61 106 controls). Exposure and outcome data were obtained from the UK Biobank and the Prostate Cancer Association Group to Investigate Cancer-Associated Alterations in the Genome (PRACTICAL) consortium, respectively. Univariable and multivariable MR analyses were employed. Sensitivity analyses were performed to detect outliers, evaluate heterogeneity, and discern potential pleiotropic effects. Utilizing data from the National Health and Nutrition Examination Survey (NHANES) database (2009-2010), we selected 1294 and 1778 men aged ≥40 years from a pool of 10 537 participants, ensuring no missing information. Regression analyses examined the associations between leafy/lettuce salad intake, daily nutrient intake, and the odds of PCa. Results: Univariable MR (UVMR) analysis reveals that the intake of pork and salad/raw vegetable correlated with an elevated PCa risk. Subsequent to confounder adjustment via multivariable MR (MVMR) analysis, a causal link was established between salad/raw vegetable intake and an increased risk of PCa (odds ratio [OR]: 1.658, 95% confidence interval [95% CI]: 1.037-2.644, P = 0.046). The analysis based on NHANES datasets demonstrated a link between leafy/lettuce salad intake and heightened odds of PCa (OR: 1.025, 95% CI: 1.003-1.049, P = 0.038). Increased daily intakes of β-carotene (original OR: 1.00006, 95% CI: 1.00001-1.00011, P = 0.024) and vitamin B1 (OR: 1.474, 95% CI: 1.104-1.967, P = 0.014) were associated with a higher likelihood of PCa. Conclusions: These MR analyses substantiate the causal nexus between salad/raw vegetable intake and PCa risk. Similarly, leafy/lettuce salad intake and the odds of PCa were significantly correlated in the cross-sectional observational study. Moreover, higher daily intakes of β-carotene and vitamin B1 were linked to an increased likelihood of PCa. These findings provide practical dietary recommendations for PCa prevention and enhance early identification and diagnosis.

RDW-SD - A more sensitive marker of anisocytosis than RDW-CV in patients with macrocytosis

Background: Anisocytosis is a variation in RBC size. This can be conventionally observed on peripheral blood smear microscopy and also by red cell distribution width, a RBC parameter obtained on automated hematology analyzers. Red cell distribution width is considered a quantitative measure of anisocytosis and does not carry subjective variation associated with microscopy and it is reported as RDW-CV % and RDW-SD. Both these values are calculated differently. Although it is one of the most frequently used hemogram parameters for anisocytosis, it is not well understood. This study aimed to compare the sensitivity of RDW-CV and RDW-SD as markers of anisocytosis in macrocytosis. Material and methods: This was a cross-sectional prospective observational study conducted in a laboratory of a tertiary care hospital in western India. The sample size of 138 was calculated at a precision 0.1 and 90% confidence interval. 138 blood samples each from patients with macrocytosis and normocytosis control group were analysed. Results: The range for RDW-CV &amp; RDW-SD was 12.59%-15.13% &amp; 40.05-47.81fl respectively in our population. Gender-wise distribution showed 72% male &amp; 28% female. The Z score value of 4.12 (&gt;1.96 is significant) reflected a significant difference in anisocytosis detection using RDW-SD compared to RDW-CV in macrocytosis. Conclusions: RDW-SD is a more sensitive marker of RBC anisocytosis than RDW-CV in macrocytosis.

A prescription audit in the ear, nose and throat outpatient department, in a tertiary care hospital: a descriptive cross-sectional study

Background: Prescription audit is a quality improvement process aimed at enhancing patient care and outcomes by reviewing prescriptions. It provides feedback to healthcare providers, (HCPs) to identify areas for improvement and ensure the quality of prescriptions. This study aims to analyse the prescription patterns and prescribing behaviour of doctors using world health organization (WHO) recommended core prescribing indicators and prescription audit guidelines from national health mission (NHM), India and implement action plan accordingly. Methods: A descriptive observational cross-sectional study was conducted for one month in the ear, nose and throat outpatient department (ENT OPD) of KMC-RI, Hubballi. A total of 96 prescriptions were analysed using WHO-recommended core indicators and additional indicators from a prescription audit template. An action plan was created to enhance prescription quality. Results: All the prescriptions contained complete demographic details of the patients, OPD registration name and date of consultation. Handwriting was legible in all 96 prescriptions with a score of 100%. Two lowest performing attributes were identified using prescription audit tool namely, allergy status and generic name with a score of 7% and 37.9% respectively. The study revealed that average number of drugs encountered was 1.9, the percentage of drugs prescribed by generic name was 37.9%, percentage of encounters with an injection prescribed was 2.08% and percentage of drugs prescribed from NLEM was 37.9%. Conclusions: The prescription audit revealed that most prescriptions adhered to WHO standards. However, improvements are needed in documenting allergy status and prescribing by generic name. An action plan with a defined timeline has been prepared to provide feedback, aiming to enhance prescription quality and ensure better healthcare outcomes.

Prevalence, Radiological, and Pathological Findings of Ossification and Calcification of the Lumbar Spinal Ligamentum Flavum: A Comparative Study with Thoracic Lesions.

This study aimed to determine the prevalence of lumbar ligamentum flavum lesions and identify correlations between radiological and pathological findings. We conducted an observational cross-sectional study of 349 patients (lumbar: n = 296, thoracic: n = 39, lumbar and thoracic: n = 14, mean age: 69 ± 12 years, male: 74%) who underwent posterior surgery for thoracolumbar spinal canal stenosis between January 2008 and April 2023 at our hospital.Computed tomography (CT) revealed that the prevalence of ligamentum flavum lesions defined as a high-density area with a CT value of 200 Hounsfield Unit or higher in the lumbar and thoracic spine was 47% (147/310) and 85% (45/53), respectively. CT showed that most patients had radiologically suspected ossification in the lumbar (90%) and thoracic spine (98%) than radiologically suspected calcification. Lumbar lesions were thinner than the thoracic lesions (2.5 vs 3.7 mm, p < 0.01). Pathological examinations were performed in specimens collected from 34 cases (lumbar: n = 13, thoracic: n = 21), and ossification was found in 62% (8/13) and 95% (20/21) of lumbar and thoracic lesions (p = 0.02), respectively. Lastly, ossification was confirmed pathologically in 72% (8/11) and 95% (19/20) of lumbar and thoracic lesions that showed ossification on imaging (p = 0.13), respectively. The literature review revealed that the prevalence of the lumbar ligamentum flavum lesions varied from 1.5 to 35% and the patient population was mostly asymptomatic.Collectively, we found that the prevalence of lumbar ligamentum flavum lesions in symptomatic patients was greater than previously reported. Histologically confirmed ossification was less common in lumbar lesions than in thoracic lesions.

Assessing the Correlation Between Retinal Arteriolar Bifurcation Parameters and Coronary Atherosclerosis.

The aim of this study was to examine the relationship between the morphological parameters of retinal arteriolar bifurcations and coronary artery disease (CAD). In this cross-sectional observational study, fundus photography was conducted on 444 participants to capture retinal arteriolar bifurcations. A total of 731 fundus photographs yielded 9625 measurable bifurcations. Analyzed bifurcation parameters included the diameters of the parent vessel (d0), the larger branch (d1), and the smaller branch (d2), as well as the angles (θ1) and (θ2) representing the orientation of each branch in relation to the parent vessel, respectively. Additionally, theoretical optimal angles ( ) and ( ), calculated from the measured parameters, provided a benchmark for ideal bifurcation geometry. The study assessed the variation in these parameters across different levels of coronary atherosclerosis severity. After adjusting for anatomical characteristics including the asymmetry ratio, area ratio, and distance to the optic disc, we observed that patients with severe coronary artery stenosis had significant deviations from the theoretical optimal bifurcation angles, with a decrease in ( ) and an increase in ( ) compared to those with moderate stenosis. The findings suggest a clear alteration in retinal arteriolar bifurcation morphology among patients with severe CAD, which could potentially serve as an indicator of disease severity.

Analysis of morphology, cytotoxicity, and water content characteristics of freeze-dried amnion membrane from human and bovine

Placenta tissue has biological advantages, including anti-inflammatory, anti-bacterial, anti-fibrotic formation, and immunomodulatory properties. The amnion membrane (AM) is an inner side membrane of the placenta that faces the fetus. The main sources of amnion are humans and animals, with bovine being one of the significant sources. The aim of this study was to analyze the morphology, cytotoxicity, and water content characteristic of freeze‑dried amnion membrane (FD‑AM) from humans and bovines to measure the safety and compatibility of bovine FD-AM as an alternative to human FD-AM. This study is an observational cross-sectional study. Samples were divided into two groups: human FD-AM and bovine FD-AM groups. Both groups were examined for morphology characteristics by scanning electron microscopy (SEM), cytotoxicity by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) analysis, and water content by drying through moisture analyzer device. The morphology characteristics of bovine FD-AM and human FD-AM, as observed through SEM, showed similar results of a smooth, flat surface with no cavity and were well dehydrated. MTT assay analysis on both groups demonstrated cytocompatibility with cell viability exceeding 70% in the control group. However, human FD-AM showed a higher number of viable cells (0.19±0.01) compared to bovine FD-AM (0.12±0.03), with a statistically significant difference (p&lt;0.05). The water content analysis revealed that both groups met the standard, with levels below 10%. While bovine FD-AM (7.19±0.45%) had slightly higher water content than human FD-AM (6.79±1.0%), the difference was not significant (p&gt;0.05). Both human FD-AM and bovine FD-AM showed good results in morphology, cytotoxicity, and water content characteristics and compatibility. In conclusion, bovine FD-AM might be considered as an alternative to human FD-AM.

Pain sensitization and pain-related psychological factors in patients with temporomandibular disorders: an observational cross-sectional study.

There is conflicting evidence on how central processing impairments affect patients with temporomandibular disorders (TMD). Moreover, there is sparse research on the assessment of endogenous pain modulation in this population through conditioned pain modulation (CPM) testing. The main objective of this observational study was to evaluate the possible differences between myofascial TDM patients and healthy pain-free controls on psychophysical variables suggestive of central processing impairments (including temporal summation (TSP), pressure pain threshold (PPT) and conditioned pain modulation (CPM)). This is a cross-sectional observational study including a sample of patients with TMD and pain-free controls recruited from private and university clinics in Spain. Outcome measures included local and distal PPTs, temporal summation, conditioned pain modulation and psychological factors of depression, anxiety, kinesiophobia, fear avoidance beliefs and pain catastrophizing. Fifty-nine patients with TMD of myofascial origin (32 years [IR: 25-43]) and 30 healthy, pain-free controls (29.5 years [IR: 25-41]) participated in the study and completed the evaluations. Patients with TMD showed significantly reduced CPM (p = 0.001; t = 3.31) and both local and distal PPTs (p < 0.05) when compared with controls, after adjusting for the influence of age and sex. TSP did not show any difference between the groups (p = 0.839; Z = 0.20). All psychological factors were higher in patients with TMD (p < 0.005), except for anxiety (p = 0.134). Patients with myofascial TMD included in this study exhibited signs of altered central processing, linked to impaired descending pain modulation, distal hyperalgesia and psychological factors like depression, kinesiophobia, fear avoidance beliefs and pain catastrophizing but not anxiety.

Serum Levels of the C-terminal Fragment of Fibroblast Growth Factor 23 (C-FGF23) and Hepcidin in Patients with Hemodialysis Undergoing Treatment with a Proline Hydroxylase Domain (PHD) Inhibitor

Background: We previously reported, for the first time, serum levels of the C-terminal fragment of fibroblast growth factor 23 (C-FGF23) in patients undergoing hemodialysis (HD). Most HD patients have undergone treatment with either recombinant erythropoietin (r-EPO) or hypoxia-inducible factor (HIF) proline hydroxylase domain (PHD) inhibitor, both of which stimulate FGF23 production and cleavage. Methods: This cross-sectional observational study involved analyzing measuring FGF-related parameters and comparing results for subgroups of patients who received either r-EPO and or a PHD inhibitor. Results: No significant difference was observed for iron-related parameters or serum hepcidin levels in both subgroups of patients. Significant differences were found for certain FGF-23-related parameters. Conclusion: Both FGF23 production and cleavage were stimulated more in patients treated with the PHD inhibitor than in patients treated with r-EPO.

Diffusion tensor imaging of vastus lateralis in patients with inflammatory myopathies.

Inflammation in patients with myositis would increase diffusion of water molecules across sarcolemma that could be detected with the help of diffusion tensor imaging (DTI). We aimed to determine an association between DTI of vastus lateralis (VL) and histopathological findings in cases of myositis and to estimate diagnostic performance of different MRI variables in predicting histopathological outcomes. This prospective cross-sectional observational study included 43 patients with myositis. MRI of bilateral thighs with DWI/DTI protocol was performed in all the patients. Thirty-three patients further underwent biopsy of right VL muscle. Imaging analysis included grading of "Muscle oedema" based on signal intensity (SI) and extent and "fatty infiltration" based on extent on conventional sequences and, acquiring DWI and DTI parameters. Gold standard method to determine inflammation in muscles was histopathological examination. Comparison of DTI/DWI variables with clinical and histopathological variables was done. The average DWI apparent diffusion coefficient (ADC) and DTI ADC values in the patients were 1.77 ± 0.35 and 2.06 ± 0.35 respectively. The average functional anisotropy (FA) was 0.39 ± 0.17 and, the 3 eigenvalues in the patients were 2.96 ± 0.63, 2.05 ± 0.32, and 1.20 ± 0.39 respectively. VL oedema SI weighted score was the best parameter for predicting effaced fascicular architecture and marked lymphocytic inflammation in endomysium on histopathology. VL fatty infiltration weighted score was the best parameter in predicting perifascicular atrophy. Addition of DWI or DTI didn't add significantly in determining active inflammation in cases of myositis.

Comparison of SF-36 and RAND-36 in Cardiovascular Diseases: A Reliability Study

Background/Objectives: Cardiovascular diseases are one of the leading causes of morbidity and mortality worldwide. Health-related quality of life is crucial to assess the impact of cardiovascular diseases and to guide therapeutic strategies. The Short Form 36 Health Survey and the RAND 36-Item Health Survey questionnaires are common tools for measuring health-related quality of life in patients with cardiovascular disease, but their reliability may vary according to the population studied. The aim of this study is to compare the reliability of the SF-36 and the RAND-36 in a population with cardiac pathology, addressing the question of which of these instruments offers a more consistent and useful measurement in this specific group. Methods: A cross-sectional observational study was carried out at the University Hospital of Burgos (Spain). A total of 413 patients with cardiovascular pathology referred to the Cardiac Rehabilitation Unit were included. Patients with incomplete data or who did not participate in the program were excluded. Internal consistency (Cronbach’s alpha), item–total correlation and reliability, and a half-and-half analysis were performed. Results: Both questionnaires showed similar and adequate reliability for patients with cardiovascular pathology. Internal consistency, as measured with Cronbach’s alpha, was above 0.80 for most dimensions, supporting its robustness. Significant inter-item and inter-dimension correlations were found in both scales, except in some specific cases in the dimension ‘Physical Functioning’. The half-and-half analysis confirmed the good reliability of both scales. Conclusions: Both the SF-36 and the RAND-36 are highly reliable tools for assessing health-related quality of life in patients with cardiovascular disease. The results may have significant implications for clinical practice, helping in the selection of health-related quality of life monitoring instruments and in the evaluation of the efficacy of therapeutic interventions.

Choroidal structural changes in inactive thyroid eye disease: a cross-sectional analysis of the choroidal vascularity index

Objective In this study, we aimed to compare choroidal vascular changes using the Choroidal Vascularity Index (CVI) between patients with inactive Thyroid Eye Disease (iTED) and healthy individuals, and to assess the relationship between CVI and choroidal thickness (CT), smoking history, and clinical parameters. Methods In this cross-sectional observational study, the eyes of 30 patients aged 18 to 45 with iTED were compared with the randomly selected eyes of 35 age and gender-matched healthy control individuals. Optical coherence tomography (OCT) scans were taken from all participants. The images were binarized using the ImageJ software, and the total choroidal area (TCA) and luminal area (LA) were measured. The ratio of the LA to the TCA was used to calculate the CVI. The relationships between these measurement parameters and clinical activity score (CAS), exophthalmometry, smoking status, and other clinical parameters were examined. Results In the iTED group, CT and CVI values were significantly higher compared to the control group (p < 0.001, p = 0.029). No significant effect of smoking on choroidal parameters was detected in the iTED group. Additionally, there was no statistical correlation between choroidal parameters and either exophthalmometry or CAS (p > 0.05). In the multivariate regression analysis, it was determined that CT showed a significant relationship with thyroid stimulating immunoglobulin (TSI) (p = 0.003). Conclusions This study found that CT and CVI were increased in the eyes of patients with iTED compared to healthy controls. The history of smoking did not appear to have any effect on CT and CVI in iTED patients.

A cross-sectional observational study of suicidal behavior among people in prison at Lajpore Central district jail, India

ABSTRACT Suicidal ideation assessment can help reduce the suicide rate among people in prison. Studies for the assessment of suicidal ideation and risk factors for suicide among inmates have been done in Western countries, but in India, data is lacking regarding the assessment of suicidal ideation among the people in prison. 1. To assess the prevalence of suicidal ideationin people in prison. 2. To identify aggravating factors for suicidal behavior. It was a cross Sectional Observational Study at a district jail, Lajpore, Surat, Gujarat. After permission from the jail authority, people in prison with or without conviction, who were willing to give consent for participation, were enrolled in the study. Semi-structured questionnaires are used to assess socio-demographic profiles. Modified Suicide Ideation scale (MSSI) and General Health Questionnaire (GHQ) and PatientHealth Questionnaire (PHQ) scales were used as materials to assess suicidal ideation and psychiatric comorbidity. Frequency analysis and Pearson correlation among various factors with the use of appropriate statistical methods. Descriptive and qualitative analysis of data was done on 140 incarcerated persons in prison. Analysis showed that 10 (7.1%) people in prison had moderate suicidal ideation in the last 48 hours while 58 (41.4%) people in prison had suicidal ideation at any point in their life. The prevalence of depressive symptoms was high among people in prison. 57.9% had minimal depressive symptoms, while 9.3% had moderate to severe symptoms. Non-convicted inmates from urban areas were having significantly more psychological distress and depressive symptoms than other inmates. Advanced ageof the inmates, negative impact of imprisonment on life, depressive symptoms, and psychosocial distress emerged as risk factors correlated with suicidal ideation. During suicide risk assessment, inmate’s age, the impact of imprisonment, psychosocial distress, and depressive symptoms should be considered as risk factors among people in prison.

Exploration of the triceps surae muscle in ambulatory children with cerebral palsy using instrumented measurements of stiffness and diffusion tensor magnetic resonance imaging for muscle architecture

BackgroundMusculoskeletal alterations causing reduced range of motion of the ankle joint are common in children with cerebral palsy (CP). Objective measurements of passive joint resistance and three-dimensional skeletal muscle volume and muscle architecture can lead to a comprehensive understanding of which factors influence joint range of motion.Research questionTo investigate the relation between the passive dorsiflexion of the ankle joint, biomechanical contributing factors to the passive joint resistance, and muscular architectural properties of the triceps surae muscle in children with CP.MethodsIn this cross-sectional observational study, 14 children with spastic CP (bilateral: 5, unilateral: 9, Gross Motor Function Classification System (GMFCS) level I:11, II:3) naïve to intramuscular tone reducing treatment, and 14 TD children were included. The passive dorsiflexion of the ankle was measured with a goniometer. Passive joint resistance and related parameters were estimated based on a biomechanical model and measurements using a motorized device, the Neuroflexor. Three-dimensional muscle architecture was quantified with diffusion tensor magnetic resonance imaging (DT-MRI).ResultsIn the CP group, the median [min, max] passive dorsiflexion was decreased in the most affected leg (MAL) compared to the less affected leg (LAL) (2.5° [-25°, 20°] vs. 12.5° [5°, 30°], p = 0.001). The stiffness coefficient (Nm/rad) in the MAL was significantly higher in children with CP compared to TD children (7.10 [3.39, 62.00] vs. 2.82 [1.24, 10.46], p = 0.015). Muscle architecture properties did not differ between CP and TD, except for pennation angle in the medial gastrocnemius (MG) of the MAL (CP 17.64° (2.29) vs. TD 21.46° (3.20), p = 0.017). The stiffness coefficient, in the MAL, correlated negatively to passive dorsiflexion (rs=-0.638) and pennation angle in medial gastrocnemius (rs=-0.964), and the non-linear coefficient (Non-linear 1) correlated negatively to the fascicle length of the medial gastrocnemius (rs=-0.857).ConclusionThis study shows that stiffness of the plantarflexors is related to decreased passive dorsiflexion of the ankle and muscle structure of the MG in high-functioning children with spastic CP. Assessments of how dynamic components as well as microscopic muscle alterations contribute to joint stiffness in the plantarflexors in individuals with CP are warranted.Trial registrationRetrospectively registered in ClinicalTrials.gov, NCT05447299. Observational study. Study start: 2019-01-15, register date: 2022-07-01.

A Non-Surgical Wearable Option for Bone Conduction Hearing Implants: A Comparative Study with Conventional Bone Conduction Hearing Aids Mounted on Eyeglasses.

This study aimed to compare the audiological benefits of a non-implantable wearable option for a bone conduction (BC) implant mounted on an arch (SoundArc) to those of traditional BC hearing aids (HAs) mounted on eyeglasses (BCHAs) in patients with moderate to severe conductive or mixed hearing loss. A preliminary cross-sectional observational prospective cohort study was conducted in the Tertiary Audiological Department, University Hospital. Fourteen adults with conductive or mixed hearing loss (PTA at 0.5-1-2-4 KHz = 67 ± 15 dB HL) who had been wearing conventional BCHAs mounted on eyeglasses for at least 3 years and had declined surgical implantation of a bone conduction hearing implant (BCHI) were included in the study. Unaided and aided pure-tone air conduction (AC) and bone conduction (BC) thresholds, as well as speech tests in quiet and noise, were recorded at baseline and in two different settings: with a BCHI mounted on SoundArc® and with their own BCHAs mounted on eyeglasses using two couplers. Participants completed questionnaires in both conditions, including the International Inventory for Hearing Aids (IOI-HA), the Hearing Handicap Inventory for Adults/Elderly (HHIA/E), the Speech, Spatial, and Qualities of Hearing Scale (SSQ), a 10-point visual analog scale (VAS), and the Fatigue Impact Scale (FIS). A significant functional gain was observed in both settings (p = 0.0001). Better speech perception in quiet and noise was observed with SoundArc compared to conventional BCHAs on eyeglasses (improvements in word repetition scores in noise: +19.3 at SNR +10 dB, p = 0.002; +12.1 at SNR 0 dB, p = 0.006; and +11.4 at SNR -10 dB, p = 0.002). No significant differences were found in IOI-HA, FIS, and HHIA/E scores. However, significantly better SSQ scores were reported for SoundArc in all domains (p = 0.0038). Although patients were accustomed to using BCHAs mounted on eyeglasses, the bone conduction wearable option of the BCHI (SoundArc) proved to be a viable alternative for adult patients with conductive or mixed hearing loss who are unable or unwilling to undergo BCHI surgery.

Physiological influences on neurovascular coupling: A systematic review of multimodal imaging approaches and recommendations for future study designs.

In this review, we have amalgamated the literature, taking a multimodal neuroimaging approach to quantify the relationship between neuronal firing and haemodynamics during a task paradigm (i.e., neurovascular coupling response), while considering confounding physiological influences. Original research articles that used concurrent neuronal and haemodynamic quantification in humans (n ≥ 10) during a task paradigm were included from PubMed, Scopus, Web of Science, EMBASE and PsychINFO. Articles published before 31 July 2023 were considered for eligibility. Rapid screening was completed by the first author. Two authors completed the title/abstract and full-text screening. Article quality was assessed using a modified version of the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A total of 364 articles were included following title/abstract and full-text screening. The most common combination was EEG/functional MRI (68.7%), with cognitive (48.1%) and visual (27.5%) tasks being the most common. The majority of studies displayed an absence/minimal control of blood pressure, arterial gas concentrations and/or heart rate (92.9%), and only 1.3% monitored these factors. A minority of studies restricted or collected data pertaining to caffeine (7.4%), exercise (0.8%), food (0.5%), nicotine (2.7%), the menstrual cycle (0.3%) or cardiorespiratory fitness levels (0.5%). The cerebrovasculature is sensitive to numerous factors; thus, to understand the neurovascular coupling response fully, better control for confounding physiological influences of blood pressure and respiratory metrics is imperative during study-design formulation. Moreover, further work should continue to examine sex-based differences, the influence of sex steroid hormone concentrations and cardiorespiratory fitness.

Bioelectrical impedance analysis (BIA) phase angle in stroke patients: A systematic review

Background and AimsPhase angle (PhA), a raw variable of bioelectrical impedance analysis (BIA), is an index of muscle structure and quality and might have a potential role in the evaluation of nutritional status.The aim of this systematic review was to evaluate in stroke patients: baseline PhA and its changes during hospital stay; the association of PhA with clinical features of patients, comorbidities, nutritional status or sarcopenia, and clinical outcomes. MethodsSystematic research on electronic databases (PubMed, Scopus, and Web of Science) up to June 14th, 2024 was performed according to PRISMA checklist.Using PECOS strategy, “P” (patients)=stroke patients, “E” (exposure)=lowest PhA values, “C” (comparison)=versus greatest PhA values, “O” (outcome)=nutritional and clinical outcomes, and “S” (study design)=all study types.Methodological quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies (NIH). ResultsEighteen papers met the inclusion criteria, with a low risk of bias. In stroke patients, evidence suggests that PhA was associated with malnutrition, sarcopenia and sarcopenic obesity, as well as with physical function. In addition, patients with low PhA had a longer hospital stay, higher inflammatory status and higher incidence of urinary tract infections and hospital-acquired pneumonia. ConclusionsSelected papers, although not conclusive, show that in acute and subacute stroke patients PhA was inversely associated with malnutrition and poor physical function. PhA could be a marker of health status and disease progression. PhA may be useful in a more comprehensive evaluation of nutritional status to be used for diagnosis and implementing therapy.

Metabolic kinetics and muscle and brain health markers in older adults, and the role of age and presence of chronic morbidities: A large cross-sectional cohort study

Background & aimsOlder adults are at risk for muscle and cognitive function decline during advanced aging, but the underlying metabolic mechanisms and the role of aging-associated chronic morbidities remain unclear. In the present study, we examined whether protein and amino acid kinetics in older adults with and without chronic morbidities are different when 50-70 and 70-90 of age and related to markers of muscle and brain health declines. MethodsIn a large cross-sectional observational study, 575 older adults from 12 trials (2014-2022) were stratified based on their age (50-70y vs. 70-95y) and the presence of chronic morbidities. The main outcomes were whole-body production (WBP) and interconversions of amino acids by stable amino acid tracers, body composition, and muscle and cognitive performance. Additionally, the association between metabolic markers and muscle and brain health was assessed. ResultsOverall lower muscle strength, muscle and fat mass, and cognitive function (p<0.03), but no mood disturbances, were found in 70-95y compared to 50-70y older adults. Presence of morbidities was associated with lower muscle strength and mass, and cognitive function, but higher visceral adipose tissue, and mood disturbances (p<0.05). Aging was associated with suppressed WBP of most amino acids, de novo arginine production, and net protein breakdown, but higher myofibrillar protein breakdown (p<0.007). Presence of morbidities was associated with lower WBP of glutamine, glutamate, histidine, isoleucine, phenylalanine, tyrosine, and net protein breakdown, and higher WBP of valine and taurine (p<0.04). Age showed significant negative correlations with WBP of nearly all amino acids, de novo arginine production and net protein breakdown (r: [-0.407, -0.136], p<0.01) but a positive correlation with WBP of myofibrillar protein breakdown (r=0.133, p=0.009). Lean mass showed positive correlations with de novo arginine production and net protein breakdown and WBP of all amino acids except for isoleucine (r: [0.16, 0.799], p<0.005). Worse cognitive performance was positively associated with WBP of tau-methylhistidine and taurine (r: [0.13, 0.141], p<0.04), but negatively associated with WBP of glycine, valine, and net protein breakdown (r: [-0.222, -0.135], p<0.05). ConclusionComprehensive phenotyping of a large group of older adults revealed differences in metabolic health in response to advanced aging and chronic morbidities. Poor muscle health accompanied by advanced aging was associated with overall metabolic downregulation, except for enhanced myofibrillar (muscle) protein breakdown. Presence of chronic morbidities was further associated with disturbed muscle health, mood, arginine, and taurine pathways, and higher visceral adipose tissue. Therefore, different phenotypes among older adults need to be considered when evaluating therapeutic approaches to improve muscle and brain health.