Evaluation Of Functions Research Articles

Evaluation of gliovascular functions of AQP4 readthrough isoforms.

Aquaporin-4 (AQP4) is a water channel protein that links the astrocytic endfeet to the blood-brain barrier (BBB) and regulates water and potassium homeostasis in the brain, as well as the glymphatic clearance of waste products that would otherwise potentiate neurological diseases. Recently, translational readthrough was shown to generate a C-terminally extended variant of AQP4, known as AQP4x, which preferentially localizes around the BBB through interaction with the scaffolding protein α-syntrophin, and loss of AQP4x disrupts waste clearance from the brain. To investigate the function of AQP4x, we generated a novel AQP4 mouse line (AllX) to increase relative levels of the readthrough variant above the ~15% of AQP4 in the brain of wild-type (WT) mice. We validated the line and assessed characteristics that are affected by the presence of AQP4x, including AQP4 and α-syntrophin localization, integrity of the BBB, and neurovascular coupling. We compared AllXHom and AllXHet mice to WT and to previously characterized AQP4 NoXHet and NoXHom mice, which cannot produce AQP4x. An increased dose of AQP4x enhanced perivascular localization of α-syntrophin and AQP4, while total protein expression of the two was unchanged. However, at 100% readthrough, AQP4x localization and the formation of higher order complexes were disrupted. Electron microscopy showed that overall blood vessel morphology was unchanged except for an increased proportion of endothelial cells with budding vesicles in NoXHom mice, which may correspond to a leakier BBB or altered efflux that was identified in NoX mice using MRI. These data demonstrate that AQP4x plays a small but measurable role in maintaining BBB integrity as well as recruiting structural and functional support proteins to the blood vessel. This also establishes a new set of genetic tools for quantitatively modulating AQP4x levels.

On the Evaluation of Higher-Harmonic-Current Responses for High-Field Spectroscopies in Disordered Superconductors

We discuss a formalism that allows for the calculation of a higher-harmonic-current response to a strong applied electric field for disordered superconducting systems described on the basis of tight-binding models with on- and/or intersite interactions. The theory is based on an expansion of the density matrix in powers of the field amplitudes, where we solve the equation of motion for the individual components. This allows the evaluation of higher-order response functions on significantly larger lattices than one can achieve with a previously used approach, which is based on a direct temporal integration of the equation of motion for the complete density matrix. In the case of small lattices, where both methods can be applied by including also the contribution of collective modes, we demonstrate the agreement of the corresponding results.

SURG-40. AWAKE CRANIOTOMY IN A MIDDLE-INCOME COUNTRY. CHALLENGES AND TECHNICAL NUANCES

Abstract OBJECTIVES Describe the first experience in this technically challenging procedure RESULTS on morbidity INTRODUCTION Awake craniotomy allows for maximal safe resection and lower incidence of adverse events. Nonetheless, it represents a technical challenge. METHODS We enroll forty patients, 18 women, and 22 men. Due to the lack of a navigation system, craniometrics points became paramount to craniotomy planning. Ultrasound is used to compensate for brain shift and confirm the tumor's exact location. We engaged in cortical and subcortical mapping and clinical evaluation of motor and sensory functions. Linguistic tests were applied. The first 24 hours are in the ICU, and an MRI is obtained. RESULTS The mean age was 51, and the mean Karfnosky scale was 80. The median size was 12 cm3. Locations were: Thirteen precentral gyri. Ten insular cortex. Eight cingulate gyri. Six supplementary motor gyri Two Supramarginal gyri. One paracentral lobe tumor. Four patients had obese morbidity, three had depression, and two had a midline displacement treated with steroids. Intraoperative, we encountered three seizures managed with cold saline, two speech arrest, and one transient hand motor deficit. Post-op adverse events were one central facial paralysis, one upper limb, and one lower limb paresthesias; all improved after 72 hours. The median length of stay is 48 hours. The median extent of resection is 93%. The mean KPS was 80 at discharge. We undertook a median of 18 months follow-up. 38 Glioblastomas(GMB) and 2 Low-Grade Gliomas(LGG) were found. The standard oncology treatment was Temozolomide and stereotaxic radiosurgery(SRS). The median time from surgery to SRS was 4.3 months. The median SRS marginal and maximal dose were 15Gy and 26Gy. The median overall survival(OS) was sixteen months, and the Progression-free survival(PFS) was ten months. CONCLUSION An awake craniotomy without the navigation system is possible; however, careful planning is essential.

Attention deficit disorder with hyperactivity: comparative analysis of executive functions between genres based on neurofeedback training

Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological disorder that presents a characteristic pattern of inattention and/or hyperactivity-impulsivity. ADHD directly affects Executive Functions (EF), responsible for regulating social behavior and cognitive skills. In the clinical context, the symptoms can present themselves in unique ways in each patient. Therefore, we can use different approaches to evaluate these symptoms. This article aims to analyze, through the evaluation of executive functions performed through psychological tests and neurofeedback, how ADHD symptoms are presented in males and females. Psychological tests Digit Span, Corsi Cubes, Verbal Fluency and Five Digit Test (FDT) were used. In addition, a neurofeedback game that adapts the Stroop test in an interactive application was applied through a Brain-Computer Interface. A tool developed was tested with 21 children, 11 with a confirmed diagnosis of ADHD and to 10 without the presence of this disorder. Through statistical analysis, we come to establish promises. The results of the neurofeedback analysis met what is expected in the literature, which demonstrate that patients with ADHD have a greater number of slow waves and less beta waves in the prefrontal cortex or, which indicate low stimulation of the central nervous system.

2 The Vietnamese Montreal Cognitive Assessment: An Evaluation of Construct Validity and Recommended Cut-off for Cognitive Impairment after TBI

Objective:Cognitive screening tools such as the Montreal Cognitive Assessment (MoCA) play an essential role in the clinical evaluation of neuropsychological functions. Despite the extensive investigations of the MoCA in English speaking countries as well as emerging adaptation work in a few Asian cultures, evidence base for the utility of the Vietnamese MoCA (MoCA-V) is lacking. This has posed a huge challenge for current and future clinical practice in Vietnam, as the country continues to assume a large burden of brain-related disorders. This study examined the construct validity of the MoCA-V and identified a cut-off score for the determination of cognitive impairment in a prevalent neurological condition in Vietnam - traumatic brain injury (TBI).Participants and Methods:Participants included 129 neurologically healthy individuals and 80 patients with moderate-to-severe TBI. All participants completed the MoCA-V, along with other common neurocognitive measures such as the Trail Making Test (TMT) Parts A and B, Vietnamese Verbal Fluency Test, and Digit Span.Results:Pearson’s correlations revealed significant, moderate correlations between performance on the MoCA-V subdomains and more comprehensive cognitive measures. Performance on the MoCA-V Attention domain was correlated with both Digit Span Forward, r(110) = .453, p < .001] and Digit Span Backward, r(110) = .303, p = .001; performance on the MoCA Language domain was correlated with the Vietnamese Verbal Fluency Test, r(107) = .334, p < .001; and performance on the MoCA Executive Function domain was correlated with the TMT-B, r(108) = -.479, p = .022. Performance on the MoCA-V was also associated with age, r(127) = -.659, p < .001, and education, r(127) = .769, p < .001, consistent with the general effects of age and education in cognitive abilities. Finally, a cut-off score of 22.5 was identified for the detection of cognitive impairment in Vietnamese people with TBI (AUC = 0.811; 95% CI = .75-.87, p < .001).Conclusions:This study provides the first evidence for the construct validity and clinical utility of the MoCA-V. Future research is necessary to cross-validate study findings among other clinical populations. Lessons learned from neuropsychological test translation and adaptation process will be discussed, particularly in the development of the administration materials and test instructions (e.g., considerations for individuals with limited formal education, influences of colonialism in the development of test stimuli).

Evaluation of vestibular functions in patients with obstructive sleep apnea syndrome

Background To determine the anatomical proximity of the vestibular nuclei to the respiratory nuclei and the effect of susceptibility of the posterior labyrinth to a hypoxic state on the vestibular system. Objective It was aimed to evaluate the possible effects of periodic hypoxia on vestibular reflexes and proprioceptive perception in patients with obstructive sleep apnea syndrome (OSAS). Material and methods The study was conducted with 40 patients diagnosed with moderate and severe OSAS and 21 healthy individuals. All individuals were evaluated with Dizziness Handicap Inventory, ocular vestibular evoked myogenic potential (oVEMP), cervical vestibular evoked myogenic potential (cVEMP), video head impulse test (vHIT), videonystagmography (VNG) and sportKAT 3000. Results In the vHIT, a statistically significant difference was found between the groups in terms of anterior and posterior semicircular canal vestibulo-ocular reflex gains (p < .05). A negative correlation was found between the lateral gain asymmetry and RALP gain asymmetry and the awake blood oxygen level in the OSAS groups. There was a statistically significant difference between the groups in terms of wave response rates cVEMP 100 dB nHL and oVEMP 100–110 dB nHL (p < .05). Conclusion and Significance It was concluded that vestibular reflexes and proprioceptive perception were affected due to periodic/chronic hypoxia in patients with moderate and severe OSAS.

Arctic curves of the four-vertex model

We consider the four-vertex model with a special choice of fixed boundary conditions giving rise to limit shape phenomena. More generally, the considered boundary conditions relate vertex models to scalar products of off-shell Bethe states, boxed plane partitions, and fishnet diagrams in quantum field theory. In the scaling limit, the model exhibits the emergence of an arctic curve separating a central disordered region from six frozen ‘corners’ of ferroelectric or anti-ferroelectric type. We determine the analytic expression of the interface by means of the Tangent Method. We supplement this heuristic method with an alternative, rigorous derivation of the arctic curve. This is based on the exact evaluation of suitable correlation functions, devised to detect spatial transition from order to disorder, in terms of the partition function of some discrete log-gas associated to the orthogonalizing measure of the Hahn polynomials. As a by-product, we also deduce that the arctic curve’s fluctuations are governed by the Tracy–Widom distribution.

Construction and evaluation of pedotransfer functions for saturated hydraulic conductivity in the granite red soil regions of southern China

Study regionSix typical regions of granite red soil in southern China. Study focusRegional large-scale Ks analysis of granite red soil in South China is still limited to a large number of repetitive and expensive workloads. It is necessary to construct Ks PTFs suitable for the granite red soil region of South China. In this study, six different regions granite red soil in South China were used to validate the prediction of classical PTFs for Ks, the best combination of predictors was screened and PTFs developed based on stepwise regression methods and machine learning algorithms. New hydrologic insights for the region(1) The coefficient of variation for Ks is 69.87% in the granite red soil region of South China, with a large spatial variability. (2) The six typical PTFs of Ks were poor predictors of Ks for soils in southern China, R2 < 0.4. (3) "Clay+Silt+Sand+BD+SOM+NCP" is the best combination of predictors of soil Ks in the granite red soil region of South China, which can be used in different machine learning algorithms. (4) The constructed MLR model “Ks= 1.501 + 0.043 ×NCP-0.995 ×BD+ 0.034 ×SOM-0.013 ×Clay” with KNN, ANN and BRT machine algorithm models have a prediction accuracy R2 greater than 0.8. This study provides different prediction models for soil Ks in the granitic regions of southern China and lays a theoretical basis for hydrological research in the these regions.

Physical frailty recovery is slower than mental frailty recovery after non-cardiac surgery in older adult patients.

Frailty is characterized by fragility and decline in physical, mental, and social activities; it is commonly observed in older adults. No studies have reported frailty status changes between the preoperative and postoperative periods, including mental and cognitive factors. Therefore, this study investigated frailty factors, including mental and cognitive functions, that change after non-cardiac surgery in older adults. Patients aged ≥ 75years who underwent non-cardiac surgery were surveyed using five tools (Eastern Cooperative Oncology Group-Performance Status (PS); handgrip strengths; Japan-Cardiovascular Health Study index (J-CHS index); Mini-Mental State Examination (MMSE); and Geriatric Depression Scale) for comprehensive evaluation of perioperative functions. The results before surgery, at discharge, and during follow-up at the outpatient clinic were compared. Fifty-three patients with a median age of 80 (IQR, 77-84) years were evaluated. MMSE scores did not change during the perioperative period. The PS and J-CHS index worsened significantly at discharge and did not improve at the outpatient clinic follow-up. The dominant handgrip strength decreased after surgery (p < 0.001) but improved during follow-up. Additionally, nondominant handgrip strength decreased after surgery (p < 0.001) but did not recover as much as the dominant handgrip strength during follow-up (p = 0.015). Changes in physical frailty and mental and cognitive functions were not identical perioperatively in older adult patients undergoing non-cardiac surgery. Physical frailty did not improve 1month after surgery, mental function recovered early, and cognitive function did not decline. This study may be important for frailty prevention in older adult patients.

Evaluation of left atrial and left ventricular functions with 3D speckle-tracking echocardiography in patients with coronary artery tortuosity.

Tortuosity in the coronary arteries is a very common entity encountered during angiography. The effect of coronary artery tortuosity (CAT) on the myocardium has not been completely investigated. The aim of the current study was to assess the effects of CAT on left atrial (LA) and left ventricular (LV) myocardial functions by 3D speckle-tracking echocardiography (3D-STE). Seventy-five patients with CAT and 80 age- and gender-matched controls who proved to have normal coronary angiograms (CAG) were enrolled into the study. Following CAG, the 2D images were obtained first, and then 3D images were obtained for strain analysis. The LAS-r, LAS-active, and LV-GLS were significantly depressed in the CAT (+) group (p<.001, p<.001, p=.012, respectively). The multivariate regression models demonstrated that LAS-r (p<.001), LAS-active (p=.009), and LV-GLS (p=.024) were found to be independent factors predicting CAT. The current study is the first to focus on the assessing both LA and LV myocardial dynamics in CAT (+) patients by strain echocardiography. The results of our study support the patients with CAT may have subclinical LA and LV myocardial involvements.

Clinical and Functional Analyses of an African-ancestry Gain-of-function HOXB13 Variant Implicated in Aggressive Prostate Cancer

BackgroundRecent reports have uncovered a HOXB13 variant (X285K) predisposing to prostate cancer in men of West African ancestry. The clinical relevance and protein function associated with this inherited variant are unknown. ObjectiveTo determine the clinical relevance of HOXB13 (X285K) in comparison with HOXB13 (G84E) and BRCA2 pathogenic/likely pathogenic (P/LP) variants, and to elucidate the oncogenic mechanisms of the X285K protein. Design, setting, and participantsReal-world data were collected from 21,393 men with prostate cancer undergoing genetic testing from 2019 to 2022, and in vitro cell-line models were established for the evaluation of oncogenic functions associated with the X285K protein. Outcome measurements and statistical analysisGenetic testing results were compared among patient groups according to self-reported race/ethnicity, Gleason scores, and American Joint Committee on Cancer stages using the exact test. Oncogenic functions of X285K were evaluated by RNA sequencing, chromatin immunoprecipitation sequencing, and Western blot analyses. Results and limitationsHOXB13 (X285K) was significantly enriched in self-reported Black (1.01%) versus White (0.01%) patients. We observed a trend of more aggressive disease in the HOXB13 (X285K) and BRCA2 P/LP carriers than in the HOXB13 (G84E) carriers. Replacement of the wild-type HOXB13 protein with the X285K protein resulted in a gain of an E2F/MYC signature, validated by the elevated expression of cyclin B1 and c-Myc, without affecting the androgen response signature. Elevated expression of cyclin B1 and c-Myc was explained by enhanced binding of the X285K protein to the promoters and enhancers of these genes. The limitations of the study are the lack of complete clinical outcome data for all patients studied and the use of a single cell line in the functional analysis. ConclusionsHOXB13 (X285K) is significantly enriched in self-reported Black patients, and X285K carriers detected in the real-world clinical setting have aggressive prostate cancer features similar to the BRCA2 carriers. Functional studies revealed a unique gain-of-function oncogenic mechanism of X285K protein in regulating E2F/MYC signatures. Patient summaryThe HOXB13 (X285K) variant is clinically and functionally linked to aggressive prostate cancer, supporting genetic testing for X285K in Black men and early disease screening of carriers of this variant.

FRI314 Prolactinoma And Macroprolactin; A Diagnostic Dilemma

Abstract Disclosure: A. Farooqi: None. S. Dewan: None. J. Jun: None. Prolactin is a 199 amino acid, 23 (Kilo Dalton) kDa protein secreted by pituitary lactotroph cells. The two other major forms of prolactin present in circulation are big prolactin, the dimeric 40-60 kDa prolactin and big-big prolactin or macroprolactin, 100-150 kDa complexes of 23 kDa prolactin and IgG autoantibodies. Hypothalamic dopamine is the primary regulator of prolactin secretion through its inhibitory effect. Prolactinoma accounts for ∼40% of pituitary tumors with clinical presentations of hypogonadotropic hypogonadism and tumor-related mass effects. A 77-year-old female with a past medical history of hypertension and hyperlipidemia was admitted after a mechanical fall. She underwent a computed tomography (CT) of the brain which incidentally showed a pituitary mass. Magnetic resonance imaging (MRI) of pituitary showed a homogenously enhanced 3.0 x 3.5 x 2.8 cm mass centered in the Sella turcica, invading the supra-seller cistern, left cavernous sinus, and orbital apex abutting the optic chiasm and optic tracts. The patient did not report headache, nausea, vomiting, visual changes, or abnormal milky nipple discharge. Physical examination was unremarkable without any neurologic deficit. Formal ophthalmology evaluation showed intact extra ocular movements, visual field-testing using octopus 24-2 and Humphrey test showed few missed points, though not suggestive of pituitary related loss. Serum prolactin was measured at 1432 ng/ml (reference range, 0-25). The presence of macroprolactin was considered due to the absence of clinical features of hyperprolactinemia. The monomeric prolactin was found to be 68.7% (&amp;lt;40%) at 867.5 ng/ml of the total prolactin at 1259.7 ng/ml with 31.3 % of other prolactin forms are present. Evaluation for other pituitary functions was unremarkable with thyroid stimulating hormone (TSH) of 0.72 uIU/ml (0.49-4.76l), morning serum cortisol of 52.9 ug/dl (6.7-22.4), and insulin like growth factor (IGF-1) 73 ng/ml (20-214). Cabergoline 0.5 mg twice weekly was prescribed. This case illustrates a menopausal state as a probable explanation for lack of clinical features of hyperprolactinemia with macro adenoma while macroprolactin should be considered. Presentation: Friday, June 16, 2023

SAT362 Low-dose DHT’s Effects On Gluconeogenesis And Energy Metabolism Are Ameliorated By Central Nervous System Knockout Of The Androgen Receptor

Abstract Disclosure: V. Ubba: None. S. joseph: None. R. Akbar: None. M. Dsilva: None. S. Wu: None. Polycystic ovarian syndrome (PCOS) is a leading cause of infertility in women of reproductive age. Mostly, the level of androgens are deviated from their physiological values in females, resulting in hyperandrogenemia. Androgen manifests its function in the cells via the Androgen Receptor (AR), making it a prime factor for studying PCOS pathophysiology. We generated central nervous system (CNS) specific AR knockout mouse (SynARKO), using synapsin promoter driven cre, to examine its role under normal and hyperandrogenemic conditions in female mice. Assessment of reproductive parameters under physiological levels of androgens, revealed no differences in the cyclicity and fertility of SynARKO mice when compared to Control (Con-veh) mice. These parameters were altered under hyperandrogenemia (induced using DHT) in Control mice (Con-DHT) mice and were not rescued in the SynARKO- DHT mice, suggesting CNS AR is dispensable to reproductive features in females. Evaluation of metabolic functions by Glucose tolerance test, we observed alleviated glucose intolerance in SynARKO-DHT (4 months). Energy expenditure and food intake were increased in Con-DHT mice compared to Con-veh, while showing no further differences in SynARKO-DHT mice compared to SynARKO-veh. At the molecular level, DHT treatment showed increased phosphorylated Akt in hypothalamus of control mice. Interestingly, it was restored in synARKO upon DHT treatment. Further, the inflammation marker, phosphorylated NF-kB p-65, was increased in the hypothalamus of Con-DHT mice. Additionally, IBA, a marker of macrophage activation was also increased upon DHT treatment in control mice. Taken together, our results suggest that while the reproductive functions are not mediated by the CNS AR, metabolic effects caused by hyperandrogenemia, is regulated by the central nervous system AR. Presentation Date: Saturday, June 17, 2023

A Different Scintigraphic Perspective on the Systolic Function of the Left Ventricle-1.

The aim of this study was to analyze the systolic part of the left ventricular (LV) volume curve obtained by gated myocardial perfusion imaging with the formula used in exponential decay and to investigate the clinical value of the results. One hundred fifty eight patients were retrospectively enrolled in the study. The study group was divided into three groups as normal, ischemia, and infarct. The systolic portion of the LV volume curve was also analyzed using the exponential decay formula. The scintigraphic parameter obtained using this formula is called the ejection constant (Ec). The Ec results were 1.8±0.8, 2.7±0.9, 3.5±1 in infarct, ischemia, and normal groups, respectively, and the difference in Ec results between the groups was statistically significant (p≤0.001). It appears that Ec may play a clinical role as a scintigraphic parameter in the evaluation of systolic functions of the left ventricle.

A simple formula for coherent specular reflection loss of underwater sound from rough ocean surfaces

The interaction of underwater sound with rough sea surfaces affects its propagation. The interaction may involve several coupled mechanisms: (1) a rough air-sea interface scatters and spreads the incident sound energy over a range of angles, (2) entrapped sub-surface air bubbles absorb and scatter sound energy, and (3) medium of bubble clouds refract sound energy upwards. In this paper, we ignore the effect of bubbles and consider the effect of rough air-sea interface only. We further limit our consideration to the coherent component in the specular direction. Two simple closed-form formulas are often used to model the coherent reflection loss from rough ocean surfaces. One is derived from perturbation approximation and suitable for smaller grazing angles. The other is from Kirchhoff approximation and suitable for larger grazing angles. More accurate approximations over a wide-range of grazing angles require numerical evaluation of integrals or complex special functions. In this work, we simplify and adapt earlier results by other authors to obtain a simple expression that transits from the perturbation to the Kirchhoff formulas as grazing angle increases. The new simple analytical formula is easy to use and compares well with results from complex numerical methods.

Development and functional evaluation of pedotransfer functions for estimating soil hydraulic properties in Portuguese soils: Implications for soil water dynamics

Accurate knowledge of soil hydraulic properties is essential for effectively simulating soil water dynamics in field plots. However, determining these properties directly can be challenging, especially when a large amount of data is required. Therefore, the primary objective of this study was to develop four hierarchical pedotransfer functions (PTFs) to estimate the soil hydraulic parameters of the Mualem-van Genuchten model. The PTFs that were developed ranged from utilizing a limited set of variables to those comprising a more comprehensive set of variables. These included particle size distribution, soil bulk density, soil depth, and soil water contents at matric potentials of −33 and − 1580 kPa. The functional performance of these PTFs was also assessed in simulations of the soil water balance in ten agricultural fields over two growing seasons using the HYDRUS-1D model. The simpler PTFs exhibited moderate accuracy in estimating soil water contents at different matric potentials, while the more complex PTFs with a greater number of variables yielded increasing accuracy. However, estimation errors were more noticeable in the drier range of the soil water retention curve. The inclusion of bulk density as a predictor only affected the wetter range of the same curve. Estimation of log Ks improved from the simpler to the more complex PTFs, but the statistical indicators were consistently modest. The functional performance of the PTFs showed increased errors in simulating soil water contents in the ten study sites compared to reference simulations. The more complex PTFs with the greatest number of variables provided the best predictions in most cases. The PTFs primarily affected flow conditions in the soil profile, resulting in increased soil water storage and impacting predictions of deep percolation the most. Water availability in the soil profile then influenced actual transpiration, alleviating stress in some cases but causing waterlogging in one situation. The study emphasizes the cautious use of the PTFs and the need for additional information on clay-rich soils and hydraulic conductivity data to enhance their performance.

Personnel Regulation at the Secretariat of the Attorney Commission of the Republic of Indonesia

This study aims to examine the normativity of the Non-State Civil Apparatus in supporting the duties and functions of the Attorney Commission and analyze the Secretariat’s personnel normativity based on Ministerial Letter Number B/185/M.SM.02.03/2022. This study uses normative legal research with a statute approach. The collected legal material is then qualitatively analyzed to describe the problem and answer the study objectives. The results show that the Technical Service Division of the Secretariat provides adequate technical support for addressing the behavior and performance of 28,435 Prosecutors and the Attorney General’s Office personnel. Meanwhile, the existence of six Legal Product Analysts and two Office Administrative Staff as Non-State Civil Apparatus interacting directly with the Technical Service Division of the Secretariat becomes vulnerable due to Ministerial Letter Number B/185/M.SM.02.03/2022. This letter, restricting government personnel professions to only Civil Servants and PPPK, initiates a series of changes in human resource management targeted for completion by November 28, 2023. Therefore, Personnel Development Officers in the Coordinating Ministry and the Head of the Secretariat are recommended to promptly conduct a comprehensive evaluation of personnel structures and functions. Specifically, there need to be concrete steps to balance functional needs, such as increasing the number of personnel in the Secretariat. Furthermore, it is crucial to ensure the personnel transition for six Legal Product Analysts and two Office Administrative Staff so they can continue contributing where their personnel status does not conflict with Ministerial Letter Number B/185/M.SM.02.03/2022. Lastly, it would be prudent to implement a continuous evaluation mechanism, both in the short and long term, to monitor the effectiveness and efficiency of human resource management post-adaptation of the said policy.

Evaluation of Vestibular Functions in a Case of Vestibular Migraine With Successful Treatment With Erenumab.

This is the first report of vestibular examinations before and after the successful treatment of vestibular migraine (VM), a common cause of recurrent vertigo, with calcitonin gene-related peptide (CGRP) receptor inhibitor. We evaluated a 42-year-old female with VM and concomitant probable Meniere's disease, whose headache and dizziness have improved promptly with the administration of erenumab, a CGRP receptor inhibitor. The sensorineural hearing loss in pure-tone audiometry, dysfunctions shown in vestibular examinations (cervical and ocular vestibular evoked myogenic potentials), and mild endolymphatic hydrops shown in gadolinium-enhanced inner ear magnetic resonance imaging, all in the right ear, revealed no change compared with those observed before treatment. This case suggests that VM may be treated by blocking CGRP in the trigeminal ganglion, which suppresses the effects on the vestibular nucleus; herein, no effects were observed in the inner ear despite the clear amelioration of dizziness.

The evaluation of cardiac functions in deep Trendelenburg position during robotic-assisted laparoscopic prostatectomy.

This study aimed to demonstrate the reliability of the cardiac cycle efficiency value through its correlation with longitudinal strain by observing the effect of the deep Trendelenburg position. A prospective, observational study. Single center. Between May and September 2022, the hemodynamic parameters of 30 patients who underwent robotic assisted laparoscopic prostatectomy under general anesthesia were prospectively evaluated. All invasive cardiac monitoring parameters and longitudinal strain achieved transesophageal echocardiography were recorded in pre-deep Trendelenburg position (T3) and 10th minute of deep Trendelenburg position (T4). Delta values were calculated for the cardiac cycle efficiency and longitudinal strain (values at T4 minus values at T3). The estimated power was calculated as 0.99 in accordance with the cardiac cycle efficiency values at T3 and T4 (effect size: 0.85 standard deviations of the mean difference: 0.22, alpha: 0.05). At T4, heart rate, pulse pressure variation, cardiac cycle efficiency, dP/dt and longitudinal strain were significantly lower than those at T3 (p = 0.009, p < 0.001, p < 0.001, and p < 0.001, respectively). There was a positive correlation between the delta-cardiac cycle efficiency and delta-longitudinal strain (R2 = 0.36, p < 0.001). Although the absence of significant changes in mean arterial pressure and cardiac index after Trendelenburg position suggests that cardiac workload has not changed, changes in cardiac cycle efficiency and longitudinal strain indicate increased cardiac workload due to increased ventriculo-arterial coupling.

Assessment of disturbed functions in patients with chronic heart failure using International classification of functioning ICF categories

BACKGROUND: The evaluation of impaired functions in patients with cardiac diseases is traditionally based on the clinical signs of the disease and instrumental hemodynamic parameters, without affecting all other disorders that occur with this pathology. The International classification of functioning is based on the functioning of the patient in his/her environment; therefore, a consistent assessment of the entire complex of impaired functions of the patient is appropriate, allowing for a more accurate formulation of the goals of rehabilitation and controlling the main stages of rehabilitation.&#x0D; AIM: To evaluate the International classification of functioning for assessing all impaired functions in patients with chronic heart failure.&#x0D; MATERIALS AND METHODS: The study included 68 patients with decompensated chronic heart failure. The analyzed sample included patients with chronic heart failure stages 2B and 3 (NYHA classes IIIIV). The average patient age was 63.9 years, and the average disease duration was approximately 7 years. The sample was predominantly men (66.5%). The etiology of chronic heart failure was represented by uncontrolled arterial hypertension (92%), post-infarction cardiosclerosis (74%), ischemic cardiomyopathy (25%), and chronic obstructive pulmonary disease (12%). Radiation diagnostic methods were used to confirm the severity of cardiac decompensation. The study assessed impaired functions in accordance with the domains of the International classification of functioning, mainly in functions of the cardiovascular system.&#x0D; RESULTS: In this study, 68 patients had decompensated chronic heart failure stages 2B and 3 (NYHA classes IIIIV). Group 1 included 40 patients, and group 2 included 28 patients. The instrumental examination revealed a more pronounced decrease in left-ventricular ejection fraction in group 1 compared with group 2 (42.84.4 and 49.25.6, respectively), showing a significant difference (p 0.05). Other hemodynamic parameters did not differ significantly in the groups. In the analysis of a basic set of the International classification of functioning domains for patients with chronic heart failure, the following domains turned out to be the most significant: heart function (b410), forced myocardial contraction (b4102); heart rate (b4100); blood supply to the heart (b4103); blood pressure functions (b420): increase (b4200), decrease (b4201), maintenance (b4202); functions of the respiratory system (b440) including the respiratory rate (b4400); additional functions and sensations from the cardiovascular and respiratory systems (b450-469); exercise tolerance functions (b455); water balance (b5450), including water retention (b45500), characterizing the presence of edematous syndrome; and muscle strength functions (b730). The indicated domains were also supplemented with Section d (activity and participation) walking long distances (d4501) and doing housework (d640); and Domain e (environmental factors), i.e., help from the next of kin (e310).&#x0D; CONCLUSIONS: A set of domains of the International classification of functioning for patients with decompensated heart failure has been developed and proposed, which makes it possible to more effectively identify the key problems of people with disability and more objectively form a plan for complex rehabilitation, which largely determines the prognosis in these patients.