Low Normal Values Research Articles

Influence of Apparatus Scale on Geogrid Monotonic and Cyclic/Post-Cyclic Pullout Behavior in Cohesive Soils

Geosynthetics have increasingly been applied to geotechnical engineering works due to their numerous advantages, including cost-effectiveness and their significant role in sustainable development. When geosynthetics are used as reinforcement in earth structures, such as embankments, retaining walls and bridge abutments, soil–geosynthetic interface shear behavior is a critical parameter involved in the design. This paper presents a series of monotonic and cyclic/post-cyclic pullout tests carried out to examine the apparatus scale effect on the pullout response of a geogrid embedded in two different soils. To assess the small-scale equipment feasibility, comparisons were made between pullout test parameters derived from small- and large-scale equipment. The test results indicate that, under a low confining stress of 25 kPa, using a smaller-sized apparatus results in lower values of geogrid pullout resistance and maximum mobilized shear stress, but higher values of confined tensile stiffness at low strains. On the other hand, as the confining stress increases (i.e., 50 kPa and 100 kPa), the difference between the results becomes less significant and similar trends are observed regardless of the equipment type. Adopting small-scale equipment enables obtaining soil–reinforcement interaction parameters using test procedures that are less time-consuming than those associated with large-scale pullout tests. However, proper scale effect correction factors may be considered for more consistent estimates of the interface strength parameters under low normal stress values.

Copper migration and enrichment in the mantle wedge: Insights from orogenic peridotites and pyroxenites

The refertilized mantle wedge is an important source of ore-forming metals in subduction-related Cu–Au deposits. However, the source and migration of Cu in the mantle wedge are poorly constrained. Here, we present a combined study of the Cu elemental and isotopic compositions (δ65Cu) as well as Fe3+/∑Fe ratios on a well-characterized suite of the Mg-lherzolites, Fe-rich peridotites and pyroxenites from the Bohemian Massif in a Variscan subduction zone. The Mg-lherzolites represent melting residues moderately affected by metasomatism of slab-derived melts/fluids. The Fe-rich peridotites and pyroxenites are, respectively, results of Mg-lherzolite-melt reaction and crystalline products of evolved melts in the lithospheric mantle.The peridotites and pyroxenites display higher Fe3+/∑Fe ratios (0.14–0.56) than the cratonic peridotites and mid-ocean ridge basalts, indicating that the mantle wedge was oxidized by slab-derived components. The Mg-lherzolites have relatively low Cu contents (7.35–39.6 μg/g) and normal mantle-like δ65Cu values (−0.13 to 0.26 ‰), suggesting an insignificant slab-to-mantle wedge Cu transfer. In contrast, the Fe-rich peridotites and pyroxenites have variable but overall high Cu contents (37.0–513 μg/g) and heavier δ65Cu values (up to 0.83 ‰). These signatures are ascribed to secondary sulfide precipitation from the evolved Cu- and 65Cu-enriched melts, which were produced by reaction of Mg-lherzolites with subduction-related oxidative SiO2‐undersaturated basaltic melts. Such melt-peridotite reaction at high oxygen fugacity can cause the partial oxidative decomposition of primary sulfides in peridotites with the preferential release of 65Cu into the evolved melts. Our results thus demonstrate that oxidative melt-rock reaction can result in the Cu migration, redistribution and its local enrichment in the mantle wedge, which may serve as an important source of Cu for subduction-related porphyry copper deposits.

Low ankle–brachial index is associated with higher cardiovascular mortality in individuals with nonalcoholic fatty liver disease

Background and aimsAnkle brachial index (ABI) is a risk factor for cardiovascular mortality, but it is unclear whether ABI is associated with cardiovascular mortality in patients with nonalcoholic fatty liver disease (NAFLD). The current study aimed to evaluate the association between ABI with cardiovascular and all-cause mortality in patients with NAFLD.MethodsWe performed a cohort study using the data of the1999–2004 National Health and Nutrition Examination Survey data of adults. Mortality data were followed up to December 2015. NAFLD was defined by the hepatic steatosis index or the US fatty liver index. ABI was classified into three groups: ABI ≤ 0.9 (low value); 0.9 < ABI ≤ 1.1 (borderline value); ABI greater than 1.1 (normal value).ResultsWe found that low ABI was associated with an increased risk of cardiovascular mortality in patients with NAFLD (HR: 2.42, 95% CI 1.10–5.33 for low value ABI vs normal value ABI, P for trend = 0.04), and the relationship was linearly and negatively correlated in the range of ABI < 1.4. However, low ABI was not associated with all-cause mortality in patients with NAFLD. Stratified by cardiovascular disease, ABI remains inversely correlated with cardiovascular mortality in NAFLD patients without cardiovascular disease. Stratified by diabetes, ABI is inversely correlated with cardiovascular mortality in NAFLD patients regardless of diabetes status.ConclusionsLow ABI is independently associated with higher cardiovascular mortality in NAFLD cases. This correlation remains significant even in the absence of pre-existing cardiovascular disease or diabetes.

Peran Ambideksteritas Dinamis dalam Efektivitas Pimpinan dan Dukungan Organisasi terhadap Pemecahan Masalah di Home Industri Bapak Sukir Desa Wedoro

This study aims to determine the role of dynamic ambidexterity in the effectiveness of leadership and organizational support for problem solving in the home industry of Mr. Sukir Wedoro Village. This research method uses quantitative methods. The population in the study was about 40 employees located in Wedoro, East Java. In this study, using primary data by distributing questionnaires to each employee in the home industry. For data testing carried out using validity tests, reliability tests, respondent characteristics, normality tests, multicholinearity tests, heterochedasticity tests, linear regression analysis, hypothesis test (Partial Test, Simultaneous Test), and coefficient of determination. The data were processed using multiple linear regression analysis after testing for validity and reliability. (1) Leadership Effectiveness has no positive and significant effect on Problem Solving, (2) Dynamic Ambidexterity has a positive and significant effect on Problem Solving, (3) Organizational Support has a positive and significant effect on Problem Solving. This research contributes to understanding the Role of Dynamic Ambidexterity In Leadership Effectiveness And Organizational Support Towards Problem Solving. Based on the results of the analysis, not all variables have a positive and significant effect except for the Leadership Effectiveness variable does not have a positive and significant effect on Problem Solving. In addition to the Leadership Effectiveness variable, other variables such as the Dynamic Ambidexterity variable and the Organizational Support variable have a positive and significant effect. This research was only conducted in Mr. Sukir's industrial home in Wedoro village. Therefore, the collected data has a low normal level value

Temporary and highly variable recovery of neuromuscular dysfunction by electrical stimulation in the follow-up of acute critical illness neuromyopathy: a pilot study

BackgroundIn sepsis-associated critical illness neuromyopathy (CIPNM) serial electrical stimulation of motor nerves induces a short-lived temporary recovery of compound muscle action potentials (CMAPs) termed facilitation phenomenon (FP). This technique is different from other stimulation techniques published. The identification of FP suggests a major functional component in acute CIPNM.MethodsFrom our previous study cohort of 18 intensive care unit patients with sepsis associated CIPNM showing profound muscle weakness and low or missing CMAPs on nerve conduction studies, six patients with different severity could be followed. In a pilot sub-study we analyzed the variability of FP during follow up. Over up to 6 weeks we performed 2–6 nerve conduction studies with our novel stimulation paradigm. Motor nerves were stimulated at 0.2–0.5 Hz with 60–100 mA at 0.2–0.5 ms duration, and CMAP responses were recorded. Standard motor nerve conduction velocities (NCV) could be done when utilizing facilitated CMAPs. Needle electromyography was checked once for spontaneous activity to discover potential denervation and muscle fiber degeneration. Serum electrolytes were checked before any examination and corrected if abnormal.ResultsIn all six patients a striking variability in the magnitude and pattern of FP could be observed at each examination in the same and in different motor nerves over time. With the first stimulus most CMAPs were below 0.1 mV or absent. With slow serial pulses CMAPs could gradually recover with normal shape and near normal amplitudes. With facilitated CMAPs NCV measurements revealed low normal values. With improvement of muscle weakness subsequent tests revealed larger first CMAP amplitudes and smaller magnitudes of FP. Needle EMG showed occasional spontaneous activity in the tibialis anterior muscle.ConclusionIn this pilot study striking variability and magnitude of FP during follow-up was a reproducible feature indicating major fluctuations of neuromuscular excitability that may improve during follow-up. FP can be assessed by generally available electrophysiological techniques, even before patients could be tested for muscle strength. Large scale prospective studies of the facilitation phenomenon in CIPNM with or without sepsis are needed to define diagnostic specificity and to better understand the still enigmatic pathophysiology.Trial registration: This trial was registered at the Leipzig University Medical Center in 2021 after approval by the Ethics Committee.

Comparison of early postoperative results in patients with and without diabetes with low ejection fraction and normal serum creatinine values who underwent coronary artery bypass operation.

Low left ventricular ejection fraction and renal insufficiency are factors that increase the risk of coronary artery bypass graft surgery in patients with diabetes mellitus. The aim of this study was to group patients with low left ventricular ejection fraction undergoing coronary artery bypass graft surgery according to the presence or absence of diabetes mellitus and to evaluate postoperative changes in serum creatinine levels and postoperative outcomes. A total of 93 patients undergoing isolated coronary artery bypass grafting were included in this single-centre, retrospective, cohort study. Patients with a pre-operative low left ventricular ejection fraction of less than 35% were included in the study. Patients were divided into diabetic and non-diabetic groups and intra- and intergroup values were compared. Pre-operative, and postoperative days 2 and 5 serum creatinine levels of the patients were measured and compared. Of the 93 patients included in the study, 60 were in the diabetic group (group 1) and 33 were in the non-diabetic group (group 2). Postoperative 2- and 5-day creatinine levels were significantly higher in group 1 than in group 2 (p = 0.033 and p = 0.005, respectively). Postoperative 2- and 5-day creatinine levels were significantly higher than pre-operative creatinine levels in group 1 (p = 0.008 and p = 0.001, respectively). The intensive care unit stay was significantly longer in the diabetes mellitus group than in the group without diabetes mellitus (p = 0.031). Following coronary artery bypass graft surgery in patients with low left ventricular ejection fraction, which is already a risk factor, creatinine levels were found to have increased in the diabetes mellitus group.

SAT222 More Than Skin Deep: A Case Of Psoriasis Associated With Hypoparathyroidism

Abstract Disclosure: G. Sheth: None. M. Alsayed: None. Introduction: Primary hypoparathyroidism is commonly encountered post-surgically, however isolated cases are rarely seen without clear risk factors. Severely low calcium levels have been shown to correlate with flare ups and worsening of psoriasis. Treatment of hypocalcemia has been thought to improve and prevent the progression of this skin rash. This case highlights an interesting presentation of psoriasis in which the severity was likely related to hypocalcemia. Clinical Case: 25 y/o F with no prior past medical history presented to the emergency room with diffusely worsening skin rash and fever. She had bilateral erythematous plaques on her anterior legs for a few months that was progressively worsening. A few days prior, she started noticing erythema and scaling on her upper body and back. Her on arrival labs were remarkable for a calcium level of 4.5 mg/dL (8.8-10.4). Patient declined any symptoms at the time but did state she had noticed tingling in her face and hand/foot cramps occurring on and off over the last 6 months. Her EKG was remarkable for a mildly prolonged QT interval. She was treated with IV calcium gluconate 4 grams without improvement in her calcium. She ultimately was placed on a calcium gluconate drip and oral calcium carbonate 2 grams every 2 hours. Meanwhile, her work up revealed a PTH of &amp;lt;6 pg/mL, phosphate of 7 mg/dL, magnesium of 1.7 mg/dL, and vitamin D of 23 ng/mL. To elucidate the cause of her newly diagnosed primary hypoparathyroidism, iron studies were ordered to rule out hemochromatosis and ceruloplasmin to rule out Wilson’s disease, both of which returned negative. She had no history of radiation therapy or prior blood transfusions. She denied any family history of calcium disorders. Therefore, PTH antibody testing was sent to a send out lab and is currently pending. Patient was ultimately weaned off of the calcium drip with low normal calcium values around 7.5-8.5 mg/dL. She was placed on calcium carbonate 2 grams every 6 hours with plans for close outpatient labs and follow up. She was seen by dermatology in the hospital and was diagnosed with erythrodermic psoriasis. She was given an IL-17 inhibitor, Taltz, with significant improvement in her rash over her 2 day hospital stay. Conclusions: This case brings to light the importance of a thorough investigation of primary hypoparathyroidism and to recognize the rare genetic or autoimmune etiology as a possibility. Additionally, this case identifies the association of psoriasis with hypocalcemia. Studies have recognized a correlation of severity of psoriasis in patients with low calcium as was seen in this patient. Moreover, treatment with calcium supplementation may have a role in improving skin manifestations. Presentation: Saturday, June 17, 2023

Coagulation Abnormalities in Pediatric Patients with β-Thalassemia, An experience at a Tertiary Care Hospital

Life expectancy in thalassemia has markedly improved due to consistent blood transfer and amenability with iron chelation therapy, therefore this improvement is conditioned with various thromboembolic problems of this prolonged disorder including thromboembolic complaints. Objective: To determine coagulation abnormalities in beta (β) thalassemia major patients who have been multi transfused. Methods: This observational study was conducted at Department of Haematology &amp; Transfusion Medicine, Children hospital &amp; University of Child Health Sciences (CH&amp;UCHS), Lahore, from October 2022 to January 2023. The study included 60 β-thalassemic patient, age less than 16 years whose samples were compared with upper and lower normal value as regards to Prothrombin Time (PT), Active Partial Thromboplastin Time (APTT), Protein S, Protein C, liver enzymes (Alanine Transaminase (ALT), Aspartate Transaminase (AST), Gamma-Glutamyl Transferase (GGT). The data were analyzed using IBM SPSS version 23.0. Results: When values were compared, natural clotting inhibitors (Protein S, Protein C) were remarkably reduced in β-thalassemic paeds patients (p&lt;0.001).PT and APTT were prolonged in thalassemic children (p&gt;0.05 and p&lt;0.05 correspondingly). There was substantial increase in concentrations of ALT and AST in β-thalassemic patients (p &lt; 0.001 and p &lt; 0.001 respectively) due to iron over load by multiple transfusions. Conclusions: Marked changes in coagulation inhibition supporting thrombotic tendency was observed in thalassemic children. There were reduced levels of protein C and protein S, independent of slightly prolonged PT and APTT and elevated levels of ALT, AST with normal GGT in thalassemic children.

Assessment of the Body Response to Snowmelt Water Consumption in Military Personnel Serving in the Arctic Based on Blood Parameters

Introduction: Stability of physicochemical parameters of body fluids reflects the degree of influence of environmental factors on the body. Objective: To assess the body response to snowmelt water consumption for drinking purposes in military personnel serving in the Arctic based on blood parameters. Material and methods: The study was conducted in summer 2022. We took snowmelt water samples for chemical analysis and venous samples from 51 servicemen for a complete blood count and electrolyte measurements. Results: Snowmelt testing showed that the levels of iron were 1.2–1.6, copper – 22.2, zinc – 52.1, sodium – 11.6 to 21.9, magnesium – 5.7 to 29.1, and calcium – 9.0 to 34.1 times lower than reference concentrations. Potassium levels were negligible. The length of service of the study subjects in the Arctic above the 76th parallel North was 5.7 ± 0.3 years. Blood test results showed low or lower normal values of erythrocyte count in 39.2 %, hematocrit – in 19.6 %, and mean hemoglobin – in 13.7 % of the military personnel. A high mean corpuscular volume was detected in 17.6 % of them. The proportion of stab neutrophils in the sample was 0.55 ± 0.04 % with the normal range of 1 to 6 %. The electrolyte imbalance was evidenced by high serum potassium levels in 21.6 %, a lack of ionized calcium and magnesium in 29.4 % and 17.6 %, respectively, and sodium, phosphorus, and chlorine levels at the lower limit of the normal range in 29.4 to 47.1 % of the examined. Conclusions: Snowmelt water contains low concentrations of inorganic chemicals. Its long-term daily consumption for drinking purposes leads to electrolyte imbalance in the body, such as hypotonic water overload, and is likely to affect nonspecific resistance.

The Use of DAO as a Marker for Histamine Intolerance: Measurements and Determinants in a Large Random Population-Based Survey.

Histamine intolerance (HIT) is a common adverse reaction to food where elimination and reintroduction of histamine-rich food is part of the investigation. Analysis of the enzyme diamine oxidase (DAO) is sometimes used as an additional tool for diagnosis. This study aimed to describe the distribution of DAO in a large representative cohort of adults and to determine the association between DAO activity and possible associated factors. The study is based on the population-based West Sweden Asthma Study and includes 1051 subjects. Subjects underwent structured interviews including questions on demography, asthma, allergy symptoms, and lifestyle factors. Subjects were assessed for specific-IgE-antibodies and measurement of DAO activity in serum. Previously suggested cut-off levels for low values (<3 U/mL), normal values (>10 U/mL), and median levels of DAO were used. In the group of 1051 subjects, only a few presented reactions upon histamine intake, whereas 44% presented DAO levels below the suggested normal cut-off levels. BMI and age were shown to have an impact on DAO activity among women with increasing activity of DAO with increasing BMI and age. Among men, only increasing age was seen to have an impact on DAO levels. There was no difference in DAO levels with different sensitization status to common foods or airborne allergens. No association between DAO levels and reported symptoms to histamine-rich foods could be found. In conclusion, the determination of the DAO enzyme needs to be re-evaluated and may not be used as a valuable tool for histamine intolerance using current cut-off values. Further studies are needed to improve the use of DAO as a biomarker for histamine intolerance.

Differences between leukemic arthritis and juvenile idiopathic arthritis

ObjectivesTo determine the clinical and laboratory differences between leukemic arthritis (LA) and juvenile idiopathic arthritis (JIA) at the onset of the disease.Material and methodsPatients under 16 years of age, both genders, who presented for the first time to the pediatric rheumatology service with a diagnosis of probable JIA, with arthritis and without peripheral blood blasts, in which the final diagnosis was acute lymphoblastic leukemia (ALL) or JIA. The clinical and laboratory characteristics of the patients were compared, chi-square and relative risk were used for categorical variables, and the Mann–Whitney U and T-test for the comparison of means between groups. A binary logistic regression model was developed to differentiate leukemic arthritis from JIA.ResultsA total of 76 patients, 14 with LA and 62 with JIA, were analyzed. The mean age at diagnosis was lower in the leukemic arthritis group, the female gender prevailed in the JIA group, and the time to onset of symptoms was lower in the leukemic arthritis group. Patients with leukemic arthritis showed increased pain intensity, fever, weight loss, nocturnal diaphoresis, lymph node enlargement, hepatosplenomegaly, and pain that did not improve with analgesic administration. Laboratory parameters with statistical significance were the presence of anemia, leukopenia, and neutropenia. The platelet count was significant but in a low normal value, compared to the JIA. A binary logistic regression model was developed to differentiate leukemic arthritis from JIA. The probability associated with the statistic (Chi-square) was 0.000, and the Cox and Snell R2 and Nagelkerke R2 values were 0.615 and 1, respectively. The developed model correctly classified 100% of the cases.ConclusionsThe diagnosis of acute lymphoblastic leukemia should be ruled out in patients who present with arthritis and hematological alterations, mainly leukopenia and neutropenia, with joint pain disproportionate to the degree of arthritis, predominantly at night and that does not improve with the use of analgesics, fever, lymph nodes, and hepatosplenomegaly. Criteria are suggested to differentiate both diseases.

Clinical implications of coronary microvascular dysfunction in patients with non-obstructive coronary artery disease and role of the thermodilution method.

More than 60% of patients undergoing coronary angiography present no coronary artery disease (CAD). Angina and myocardial ischemia are classically determined by epicardial vascular obstruction, but coronary microvascular dysfunction (CMD) may also represent a possible cause for these phenomena. Two endotypes of CMD have been recognized, with two different pathophysiological mechanisms: structural CMD, characterized by low coronary flow reserve (CFR) and high microvascular resistance (MVR) values; and functional CMD, characterized by low CFR and normal MVR values. According to the present data, almost half of patients with non-obstructive CAD have shown signs of CMD. For this reason, further investigations for microvascular function assessment should be considered when evaluating no-CAD patients complaining of angina or presenting signs of myocardial ischemia. The thermodilution method is currently becoming a widespread invasive technique due to its feasibility and high reproducibility for coronary physiology evaluation. Furthermore, a recently introduced technique - called continuous thermodilution - allows for direct measurement of absolute coronary flow and resistances. The role of this brand-new technique in the clinical scenario is however still to be fully investigated and its use is at present limited to research purposes only. Among no-CAD patients, both structural and functional CMD are related to a worse prognosis in term of mortality and major adverse cardiovascular events (MACE). In this review, we will discuss the present evidence supporting the definition, prevalence and clinical implication of the different forms of CMD and the technical aspects of its invasive assessment.

Peran Ambideksteritas Dinamis Dalam Efektivitas Pimpinan dan Dukungan Organisasi terhadap Pemecahan Masalah di Home Industri Bapak Sukir Desa Wedoro

&#x0D; This study aims to determine the role of dynamic ambidexterity in the effectiveness of leadership and organizational support for problem solving in the home industry of Mr. Sukir Wedoro Village. This research method uses quantitative methods. The population in the study was about 40 employees located in Wedoro, East Java. In this study, using primary data by distributing questionnaires to each employee in the home industry. For data testing carried out using validity tests, reliability tests, respondent characteristics, normality tests, multicholinearity tests, heterochedasticity tests, linear regression analysis, hypothesis test (Partial Test, Simultaneous Test), and coefficient of determination. The data were processed using multiple linear regression analysis after testing for validity and reliability. (1) Leadership Effectiveness has no positive and significant effect on Problem Solving, (2) Dynamic Ambidexterity has a positive and significant effect on Problem Solving, (3) Organizational Support has a positive and significant effect on Problem Solving. This research contributes to understanding the Role of Dynamic Ambidexterity In Leadership Effectiveness And Organizational Support Towards Problem Solving. Based on the results of the analysis, not all variables have a positive and significant effect except for the Leadership Effectiveness variable does not have a positive and significant effect on Problem Solving. In addition to the Leadership Effectiveness variable, other variables such as the Dynamic Ambidexterity variable and the Organizational Support variable have a positive and significant effect. This research was only conducted in Mr. Sukir's industrial home in Wedoro village. Therefore, the collected data has a low normal level value.&#x0D; Keywords: Leadership Effectiveness, Dynamic Ambidexterity, Organizational Support, and Problem Solving.

The Effect of Preheating Temperature on the Forming Limit Diagram of AA1050/AA7050 Al Multilayered Sheets Produced by Accumulative Roll Bonding (ARB)

Multilayered sheets of AA1050 and AA7050 Al alloys produced by hot accumulative roll bonding (ARB) are tested to estimate their forming limit diagrams (FLDs). Sheets processed with preheating at 450 and 500 °C for up to six ARB cycles are submitted to Nakazima tests with an in situ digital image correlation system and tensile tests to analyze the mechanical behavior. X‐ray measurements and electron backscatter diffraction are performed to obtain the crystallographic texture and the mesotexture, respectively, and thus characterize the heterogeneous microstructure. A bimodal grain size distribution is observed in these sheets since AA7050 layers present elongated and fine grain size with nanometric precipitates and AA1050 layers present coarser and equiaxed grains. In addition, texture analysis indicates both rolling and shear components in the sheets. The FLDs show that the forming properties did not follow the expected rule of mixtures when compared with monolithic alloy sheets. Overall, the multilayered AA1050/AA7050 processed by means of ARB at 500 °C presents better formability than that at 450 °C, due to the combination of lower anisotropy measured by the Lankford coefficients values close to 1 and low normal anisotropy Δr values.

PSAT024 A Case of Mild Autonomous Cortisol Secretion Managed with Active Surveillance

Abstract Mild autonomous cortisol secretion is characterized by the failure to suppress cortisol sufficiently after dexamethasone administration but without the stigmata of overt Cushing's syndrome. This condition, diagnosed in up to 50% of adrenal incidentalomas, has low overall rates of progression and mild cases can present a treatment dilemma. Here we describe one such case of cortisol excess well managed with a surveillance strategy rather than surgical intervention. A 49-year-old female with a past medical history of hypothyroidism was evaluated in the endocrine clinic for an incidental adrenal mass. CT imaging revealed a 2.7 cm left adrenal nodule, stable in size compared to prior imaging, with features typical of benign adrenocortical adenoma. Initial 1 mg DST with 8 am cortisol of 11.7µg/dl. Late night salivary cortisol (LNSC)level was found to be elevated at 130 ng/dl (nl&amp;lt;100 ng/dL). At that time, 24-hour urine free cortisol (UFC) was found to be borderline at 23.98 µg/day (nl&amp;lt;24 µg/day). Further testing at 6 months and 1 year from initial assessment showed persistently elevated LNSC level (110 ng/dL) and stable 24-hour UFC at 24 µg/day. Morning ACTH level was 19 pg/mL. One year after initial assessment, LNSC continued to be elevated at 0.106 µg/dL (nl &amp;lt;0.010–0.090 µg/dL) and repeat overnight 1 mg DST with 8am cortisol was unsuppressed at 10 mcg/dL representing at least two years of autonomous, mildly elevated cortisol levels. DHEA-S was low at 13.6 µg/dl (41.2 - 243.7 µg/dL). She had no history of diabetes, hypertension, obesity, hyperlipidemia or clinical osteoporosis. Her social history was negative for tobacco or alcohol abuse. Repeated physical exams were within normal limits, and she did not have any signs of central adiposity, abdominal striae, thinning of skin or hirsutism. She continued to deny any subjective symptoms of lethargy or muscle weakness. Given low normal range ACTH values, mildly increased midnight salivary cortisol, failure to suppress after 1 mg overnight DST with no clinical evidence of overt hypercortisolism, patient was diagnosed with mild autonomous cortisol secretion. She did not show any signs of hypertension, hyperglycemia or physical changes that would warrant concern for hypercortisolemic end organ effects. As the patient was largely asymptomatic, with stable CT imaging of left adrenal adenoma, left adrenalectomy was discussed but not recommended as patient preferred an observation surveillance strategy with laboratory evaluation every 6 months to monitor for hypercortisolemia. This case demonstrates that a surveillance strategy, rather than surgery, may be appropriate in selected cases of mild autonomous cortisol secretion from an incidentally discovered adrenocortical adenoma, especially when end organ effects of cortisol excess are clinically absent. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Speciation analysis of manganese against the background of its different content in the blood serum of dairy cows.

Studies in the field of microelement speciation in the body of farm animals, in particular dairy cattle, are almost completely absent. The average concentration of Mn in the blood serum of all the studied animals (n = 80) was 2.5 μg/L, which corresponds to normal values. Of the total number of animals, 21% were the cows with the low normal values (serum Mn concentration ≤ 2 µg/L, i.e. less than Q25 of the total sample) and 25% were the animals with the high normal values (serum Mn concentration ≥ 2.72 µg/L, i.e. more than Q75 of the total sample). The data obtained in the course of the study indicate that the change in the Mn level, even in the range of normal values, is accompanied by the redistribution of this element over various protein fractions. The six found Mn blood serum forms are presumably represented by α2-macroglobulin (tetramer, dimer, and monomer), transferrin/albumine, manganese citrates, and "free" metal ions. The analyzed fractions of Mn found in the blood serum of cows had the following hierarchy of concentrations: in the group with low-normal values of Mn ("free" Mn >> tetrameric form of α2-macroglobulin >> transferrin/albumine >> dimeric form of α2-macroglobulin >> monomeric form of α2-macroglobulin >> citrate), in the group with high normal manganese values ("free" Mn >> monomeric form of α2-macroglobulin >> transferring/albumine >> citrate >> tetrameric form of α2-macroglobulin >> dimeric form of α2-macroglobulin). In the group with high normal Mn values relative to the group with low normal values, there was a percentage decrease in the tetrameric fraction of a2-macroglobulin from 17.2 to 4.4%, dimeric fraction of a2-macroglobulin from 6.9 to 2.2%, "free" Mn from 54.3 to 44.4% and an increase in monomeric fraction of a2-macroglobulin from 6.7 to 23.1%, transferrin/albumine from 10.1 to 17.7%, citrate from 4.8 to 8.2%. Our data demonstrate the features of Mn redistribution of dairy cows, which can be used for an extended assessment of the microelement status of animals.

Comparative study on arterial blood gas analysis among COPD patients and non-COPD patients

Background: Chronic obstructive pulmonary disease (COPD) was confused with so many diseases but as the knowledge and medical skill advance gradually a dramatic change could be observed about all diseases. Cigarette smoking is a leading cause of COPD. Objective: The study principally aims to compare arterial blood gas analysis among patients having chronic obstructive pulmonary disease and healthy control cases. Methodology: A cross sectional study was conducted in 200 patients attended a department with 100 COPD patients and 100 healthy patients. Based on inclusion and exclusion criteria patients were recruited. All patients were under go through ABG analysis. Informed consent was obtained from each patient. P value less than 0.05 considered statistically significant. Results: The results of present study indicated that there were significantly greater alteration in the blood gases and acid base chemistry, particularly PaO2, PaCO2 in patients who show evidence of various complications mentioned earlier. Conclusion: It has thus been inferred that although COPD patients had pH within the normal range the majority of them had low normal values. This study concluded that all parameters of ABG were statistically significantly deranged in chronic bronchitis, emphysema and chronic bronchitis with emphysema patients.

Tracing carbonate dissolution in subducting sediments by zinc and magnesium isotopes

Carbonate dissolution in subduction zones transfers surface carbon to the mantle and plays an important role in regulating global carbon cycles through geologic time. Petrological observations and thermodynamic models predict substantial dissolution of subducting carbonates induced by slab-derived fluids at arc mantle depths, but this dissolution process has rarely been verified by existing geochemical tracers. In this paper we show that zinc and magnesium isotopes can serve as such tracers through a comparative study on carbonate-bearing and carbonate-free sediments from the South China Sea and the Philippine Sea that are going to be subducted. Leaching experiments are further performed to characterize the isotopic difference between dissolved carbonates and silicate components in sediments. Bulk carbonate-bearing sediments and carbonate-free sediments surprisingly have indistinguishable δ66Zn (0.26 ± 0.04‰ versus 0.25 ± 0.04‰), but the former display systematically lower δ26Mg (−0.85‰ to −0.17‰, n = 10) than the latter (−0.26‰ to +0.13‰, n = 13). Leaching experiments show that dissolved carbonates have much higher δ66Zn (0.82 ± 0.26‰) and lower δ26Mg (−2.70 ± 0.35‰) compared with the silicate residues (δ66Zn = 0.21 ± 0.06‰; δ26Mg = −0.06 ± 0.14‰). These results indicate that the presence of carbonate components has insignificant influence on Zn isotopic compositions of bulk sediments but prominent influence on their Mg isotopic compositions. In this respect, the final fate of carbonates in subducting sediments can be tracked by a combined Mg and Zn isotope analysis on mantle-derived magmas. For instance, bulk carbonate-bearing sediment addition (i.e., no carbonate dissolution) during subduction would produce low δ26Mg but normal δ66Zn values (i.e., Mg-Zn isotopic “decoupling”) in mantle-derived magmas. By contrast, if carbonate dissolution occurs during subduction, the high δ66Zn and low δ26Mg (i.e., Mg-Zn isotopic “coupling”) signals of dissolved carbonates will be transferred to the sources of mantle-derived magmas. We test this application for a Cenozoic subduction-related, arc-like volcanic exposure from Tengchong, Southwestern China and find significant Mg-Zn isotopic coupling, which demonstrates carbonate dissolution during Indian Oceanic slab subduction. Our results also shed constraints on the amount of dissolved carbonates in the sub-arc mantle. Available data reveal the absence of high δ66Zn and low δ26Mg in global arc lavas, for which we suggest to be the result of a relatively low proportion (<20%) of dissolved calcium carbonates in the sub-arc mantle.

Low FXIII activity levels in intensive care unit hospitalized COVID-19 patients

BackgroundCOVID-19 infection is associated with a hypercoagulable state. Severe COVID-19 patients present with high plasma fibrinogen levels, continuous deposition of fibrin and the presence of microthrombi in their lungs, accompanied by significant fibrinolysis, resulting in high D-dimer levels. Due to the role of FXIII in fibrin crosslinking and clot stabilization, we analyzed its activity levels and dynamics in COVID-19 patients hospitalized in the intensive care unit (ICU).MethodsFXIII levels were measured in thirty four COVID-19 patients hospitalized in the ICU and in fourteen non-severe COVID-19 patients. FVIII levels were measured for comparison. Laboratory data and clinical variables were recorded.ResultsThe average FXIII activity level in 34 ICU hospitalized COVID-19 patients was 69.9±33 %, significantly lower compared to an average of 120±20.9 % FXIII activity in 14 non-severe COVID-19 patients. FXIII activity levels were below the low normal value (< 79 % FXIII activity) in 74 % of the ICU hospitalized COVID-19 patients. In contrast, high FVIII activity was measured among all severe COVID-19 patients. Consecutive measurements, performed in fourteen ICU hospitalized COVID-19 patients, pointed to a significant decrease in FXIII activity from the average of 85.7±28.2 %, (which is in the normal range), to an average of 68.0±20.4 %, below the low normal range, within 6.4±3.4 days of ICU hospitalization. Liver functions did not differentiate between patients with low and normal FXIII activity. No inhibitor to FXIII activity was found in the plasma of severe COVID-19 patients. Levels of FXIII-A antigen correlated with FXIII activity, and were low in severe COVID-19 patients.ConclusionsLow FXIII activity levels were found in COVID-19 patients hospitalized in the ICU, with gradual decline during their hospitalization. A mechanism of consumption may account for the low FXIII activity in these patients.

PSX-B-25 Milk productivity and zinc species analysis in cattle depending on the level of lead accumulation

Abstract The aim was to study the milk productivity and zinc species in dairy Holstein cow blood serum depending on the level of lead accumulation. Fat and protein content in milk was assessed by the FIL-IDF procedure. The major zinc species in dairy cow blood serum were tested using a hybrid high-performance liquid chromatography-inductively coupled plasma-mass spectrometry technique. The lead content in the blood serum of all animals was in the intervals of the physiological standard. Animals with low-normal values (Pb concentration up to the 25th percentile) and high-normal values (Pb concentration above the 75th percentile) were taken to form comparison groups. Animals with high-normal values of lead had a statistically significant decrease of milk yield by 21.8% and daily production of fat by 16.4%. There was a tendency towards a decrease in the yield of protein and its percentage. It was found that the zinc content in all studied fractions (α 2-macro-globulin tetramer, α 2-macro-globulin dimer, albumin, citrates, total content) was statistically significantly lower (more than 4.8 times) in the group with high-normal values of lead. The change in the redistribution of zinc-binding ligands was found depending on the level of lead in the blood. The relative content of the α2-macro-globulin tetramer and α2-macro-globulin dimer was significantly higher by 7% and by 13% in the group with high-normal values of lead. There was the decrease in the level of animal productivity, the metal-ligand forms of zinc underwent changes despite the absence of a significant difference in the total level of lead in the blood serum. This indicates a high potential for the use of speciation analysis in the laboratory diagnosis and allows predicting and correcting zinc metabolism. The studies were performed in accordance with the research plan for 2019–2021 of the Federal Research Center of Biological Systems and Agrotechnologies RAS No. 0526-2019-0001.