Measures Of Clinical Severity Research Articles

Predicting Substance Use from Religiosity/Spirituality in Individuals with Cystic Fibrosis.

Religiosity and spirituality predict lower alcohol and other substance use in community samples of adolescents and adults. However, the roles of religiosity and spirituality in substance use have not been examined in individuals with cystic fibrosis (CF). Adults with CF (n = 123) completed measures of spirituality, religiosity, and substance use. Clinical measures of illness severity (e.g., BMI and %FEV1) were obtained from participants' medical records. Substance use rates for alcohol, tobacco, and marijuana were lower in this sample than those seen in the general population. Of the measured BMMRS subscales, spiritual experiences and religious commitment were significant predictors of lower alcohol use. These results suggest that personal factors of religiosity and spirituality are more important for substance use in adults with CF than participation in religious service and events or adoption of religious practices.

Magnetic resonance spectroscopy as marker for neurodegeneration in X-linked adrenoleukodystrophy

X-linked adrenoleukodsytrophy (ALD) is a genetic neuro-metabolic disorder, causing a slowly progressive myelopathy in adult male and female patients. New disease modifying therapies for myelopathy are under development. This calls for new (imaging) markers able to measure disease severity and progression in clinical trials. In this prospective cohort study, we measured cerebral metabolite levels with Magnetic Resonance Spectroscopy (MRS), and evaluated their potential as biomarkers for disease severity and neurodegeneration in ALD. We used a comprehensive protocol of 3T Magnetic Resonance Spectroscopic Imaging (MRSI) and 7T Single Voxel Spectroscopy (SVS) in a large cohort of adult ALD males without cerebral demyelination. One hundred seven baseline scans – 59 obtained in ALD patients (42 3T MRSI and 17 7T SVS) and 48 obtained in healthy male controls (32 3T MRSI and 16 7T SVS) – and 82 one and two-year follow-up scans (66 3T MRSI and 16 7T SVS) of ALD patients were included. Both protocols showed significantly lower concentration ratios of N-acetylaspartate/creatine (tNAA/tCr) and Glx (glutamine + glutamate)/tCr in the grey and white matter of patients, compared to controls. A novel finding is the higher level of inositol (Ins)/tCr and choline containing compounds (tCho)/tCr in ALD patients without cerebral demyelination. Furthermore, tNAA/tCr correlated strongly with clinical measures of severity of myelopathy. There was no detectable change in metabolite ratios after one-year or two-year follow-up. Our results imply that cerebral metabolite levels – and more specifically the tNAA/tCr ratio – measured with MRS, have potential value as (imaging) biomarkers in ALD.

Mortality at For-Profit Versus Not-For-Profit Hemodialysis Centers: A Systematic Review and Meta-analysis.

We conducted a systematic review and meta-analysis to assess differences in risk-adjusted mortality rates between for-profit (FP) and not-for-profit (NFP) hemodialysis facilities. We searched 10 databases for studies published between January 2001 to December 2019 that compared mortality at private hemodialysis facilities. We included observational studies directly comparing adjusted mortality rates between FP and NFP private hemodialysis providers in any language or country. We excluded evaluations of dialysis facilities that changed their profit status, studies with overlapping data, and studies that failed to adjust for patient age and some measure of clinical severity. Pairs of reviewers independently screened all titles and abstracts and the full text of potentially eligible studies, abstracted data, and assessed risk of bias, resolving disagreement by discussion. We included nine observational studies of hemodialysis facilities representing 1,163,144 patient-years. In pooled random-effects meta-analysis, the odds ratio of mortality in FP relative to NFP facilities was 1.07 (95% CI 1.04-1.11). Patients at FP hemodialysis facilities have 7 percent greater odds of death annually than patients with similar risk profiles at NFP facilities. Approximately 3,800 excess deaths might be averted annually if U.S. FP hemodialysis operators matched NFP mortality rates.

Immunoglobulin deficiency as an indicator of disease severity in patients with COVID-19.

Despite the pandemic status of COVID-19, there is limited information about host risk factors and treatment beyond supportive care. Immunoglobulin G (IgG) could be a potential treatment target. Our aim was to determine the incidence of IgG deficiency and associated risk factors in a cohort of 62 critically ill patients with COVID-19 admitted to two German ICUs (72.6% male, median age: 61 yr). Thirteen (21.0%) of the patients displayed IgG deficiency (IgG < 7 g/L) at baseline (predominant for the IgG1, IgG2, and IgG4 subclasses). Patients who were IgG-deficient had worse measures of clinical disease severity than those with normal IgG levels (shorter duration from disease onset to ICU admission, lower ratio of to , higher Sequential Organ Failure Assessment score, and higher levels of ferritin, neutrophil-to-lymphocyte ratio, and serum creatinine). Patients who were IgG-deficient were also more likely to have sustained lower levels of lymphocyte counts and higher levels of ferritin throughout the hospital stay. Furthermore, patients who were IgG-deficient compared with those with normal IgG levels displayed higher rates of acute kidney injury (76.9% vs. 26.5%; P = 0.001) and death (46.2% vs. 14.3%; P = 0.012), longer ICU [28 (6–48) vs. 12 (3–18) days; P = 0.012] and hospital length of stay [30 (22–50) vs. 18 (9–24) days; P = 0.004]. Univariable logistic regression showed increasing odds of 90-day overall mortality associated with IgG-deficiency (odds ratio 5.14, 95% confidence interval 1.3–19.9; P = 0.018). IgG deficiency might be common in patients with COVID-19 who are critically ill, and warrants investigation as both a marker of disease severity as well as a potential therapeutic target.

129Xe MRI as a measure of clinical disease severity for pediatric asthma

Measurement of regional lung ventilation with hyperpolarized 129Xe magnetic resonance imaging (129Xe MRI) in pediatric asthma is poised to advance our understanding of disease mechanisms and pathophysiology in a disorder with diverse clinical phenotypes. 129Xe MRI has not been investigated in a pediatric asthma cohort. We hypothesized that 129Xe MRI is feasible and can demonstrate ventilation defects that relate to and predict clinical severity in a pediatric asthma cohort. Thirty-seven children (13 with severe asthma, 8 with mild/moderate asthma, 16 age-matched healthy controls) aged 6 to 17 years old were imaged with 129Xe MRI. Ventilation defect percentage (VDP) and image reader score were calculated and compared with clinical measures at baseline and at follow-up. Children with asthma had higher VDP (P= .002) and number of defects per image slice (defects/slice) (P= .0001) than children without asthma. Children with clinically severe asthma had significantly higher VDP and number of defects/slice than healthy controls. Children with asthma who had a higher number of defects/slice had a higher rate of health care utilization (r= 0.48; P= .03) and oral corticosteroid use (r= 0.43; P= .05) at baseline. Receiver-operating characteristic analysis demonstrated that the VDP and number of defects/slice were predictive of increased health care utilization, asthma, and severe asthma. VDP correlated with FEV1 (r= -0.35; P= .04) and FEV1/forced vital capacity ratio (r= -0.41; P= .01). 129Xe MRI correlates with asthma severity, health care utilization, and oral corticosteroid use. Because delineation of clinical severity is often difficult in children, 129Xe MRI may be an important biomarker for severity, with potential to identify children at higher risk for exacerbations and improve outcomes.

Plasma Tau and Neurofilament Light in Frontotemporal Lobar Degeneration and Alzheimer Disease.

To test the hypothesis that plasma total tau (t-tau) and neurofilament light chain (NfL) concentrations may have a differential role in the study of frontotemporal lobar degeneration syndromes (FTLD-S) and clinically diagnosed Alzheimer disease syndromes (AD-S), we determined their diagnostic and prognostic value in FTLD-S and AD-S and their sensitivity to pathologic diagnoses. We measured plasma t-tau and NfL with the Simoa platform in 265 participants: 167 FTLD-S, 43 AD-S, and 55 healthy controls (HC), including 82 pathology-proven cases (50 FTLD-tau, 18 FTLD-TDP, 2 FTLD-FUS, and 12 AD) and 98 participants with amyloid PET. We compared cross-sectional and longitudinal biomarker concentrations between groups, their correlation with clinical measures of disease severity, progression, and survival, and cortical thickness. Plasma NfL, but not plasma t-tau, discriminated FTLD-S from HC and AD-S from HC. Both plasma NfL and t-tau were poor discriminators between FLTD-S and AD-S. In pathology-confirmed cases, plasma NfL was higher in FTLD than AD and in FTLD-TDP compared to FTLD-tau, after accounting for age and disease severity. Plasma NfL, but not plasma t-tau, predicted clinical decline and survival and correlated with regional cortical thickness in both FTLD-S and AD-S. The combination of plasma NfL with plasma t-tau did not outperform plasma NfL alone. Plasma NfL is superior to plasma t-tau for the diagnosis and prediction of clinical progression of FTLD-S and AD-S. This study provides Class III evidence that plasma NfL has superior diagnostic and prognostic performance vs plasma t-tau in FTLD and AD.

A Psychometric Evaluation of the Motor-Behavioral Assessment Scale for Use as an Outcome Measure in Rett Syndrome Clinical Trials.

Rett syndrome (RTT) is a neurodevelopmental disorder that primarily affects females. Recent work indicates the potential for disease modifying therapies. However, there remains a need to develop outcome measures for use in clinical trials. Using data from a natural history study (n = 1,075), we examined the factor structure, internal consistency, and validity of the clinician-reported Motor Behavior Assessment scale (MBA). The analysis resulted in a five-factor model: (1) motor dysfunction, (2) functional skills, (3) social skills, (4) aberrant behavior, and (5) respiratory behaviors. Item Response Theory (IRT) analyses demonstrated that all items had acceptable discrimination. The revised MBA subscales showed a positive relationship with parent reported items, age, and a commonly used measure of clinical severity in RTT, and mutation type. Further work is needed to evaluate this measure longitudinally and to add items related to the RTT phenotype.

Diffuse axonal injury predicts neurodegeneration after moderate-severe traumatic brain injury.

Traumatic brain injury is associated with elevated rates of neurodegenerative diseases such as Alzheimer's disease and chronic traumatic encephalopathy. In experimental models, diffuse axonal injury triggers post-traumatic neurodegeneration, with axonal damage leading to Wallerian degeneration and toxic proteinopathies of amyloid and hyperphosphorylated tau. However, in humans the link between diffuse axonal injury and subsequent neurodegeneration has yet to be established. Here we test the hypothesis that the severity and location of diffuse axonal injury predicts the degree of progressive post-traumatic neurodegeneration. We investigated longitudinal changes in 55 patients in the chronic phase after moderate-severe traumatic brain injury and 19 healthy control subjects. Fractional anisotropy was calculated from diffusion tensor imaging as a measure of diffuse axonal injury. Jacobian determinant atrophy rates were calculated from serial volumetric T1 scans as a measure of measure post-traumatic neurodegeneration. We explored a range of potential predictors of longitudinal post-traumatic neurodegeneration and compared the variance in brain atrophy that they explained. Patients showed widespread evidence of diffuse axonal injury, with reductions of fractional anisotropy at baseline and follow-up in large parts of the white matter. No significant changes in fractional anisotropy over time were observed. In contrast, abnormally high rates of brain atrophy were seen in both the grey and white matter. The location and extent of diffuse axonal injury predicted the degree of brain atrophy: fractional anisotropy predicted progressive atrophy in both whole-brain and voxelwise analyses. The strongest relationships were seen in central white matter tracts, including the body of the corpus callosum, which are most commonly affected by diffuse axonal injury. Diffuse axonal injury predicted substantially more variability in white matter atrophy than other putative clinical or imaging measures, including baseline brain volume, age, clinical measures of injury severity and microbleeds (>50% for fractional anisotropy versus <5% for other measures). Grey matter atrophy was not predicted by diffuse axonal injury at baseline. In summary, diffusion MRI measures of diffuse axonal injury are a strong predictor of post-traumatic neurodegeneration. This supports a causal link between axonal injury and the progressive neurodegeneration that is commonly seen after moderate/severe traumatic brain injury but has been of uncertain aetiology. The assessment of diffuse axonal injury with diffusion MRI is likely to improve prognostic accuracy and help identify those at greatest neurodegenerative risk for inclusion in clinical treatment trials.

The Effects of Dysphagia on Quality of Life in Stroke Survivors

Background: Oropharyngeal dysphagia is a common problem in stroke survivors. Dysphagia and its complications have negative effects on quality of life in stroke survivors. Objectives: This study aimed to investigate the impacts of dysphagia on quality of life in Iranian stroke survivors and to determine potential relationships between demographic variables and the domains of quality of life. Methods: Sixty stroke survivors (aged 60 - 75 years old) with a diagnosis of dysphagia participated in this cross-sectional study. The swallowing function of patients was evaluated by Mann Assessment Swallowing Ability (MASA). The Persian version of the Dysphagia Handicap Index (DHI) was used to determine the impacts of swallowing disorder on the quality of life. Results: The mean total and SD of DHI was 73.03 ± 10.16. There was no statistically significant relationship between sex; age, time post-onset of stroke, and DHI total score as well as its subscales (P &gt; 0.05), whereas there was a relationship between the functional subscale of the DHI and the level of education (r = 0.27, P = 0.037) and also with severity of dysphagia on the base of MASA scores (r = 0.267, P = 0.039). Besides, the severity of dysphagia was positively correlated with DHI’s total scores (r = 0.312, P = 0.017); this means that the higher the severity of dysphagia, resulting in even greater the DHI total scores, which indicates a further reduction in the patient’s quality of life. Conclusions: Based on the findings of this study, it can be concluded that dysphagia in stroke survivors has negative impacts on the quality of life. The relationship between clinical measures of dysphagia severity and quality of life also indicates that the higher the dysphagia severity the lower the quality of life. Dysphagia’s negative impact on the quality of life does not depend on age and gender.

Validation of Serum Neurofilament Light Chain as a Biomarker of Parkinson's Disease Progression.

Background:The objective of this study was to assess neurofilament light chain as a Parkinson’s disease biomarker.Methods:We quantified neurofilament light chain in 2 independent cohorts: (1) longitudinal cerebrospinal fluid samples from the longitudinal de novo Parkinson’s disease cohort and (2) a large longitudinal cohort with serum samples from Parkinson’s disease, other cognate/neurodegenerative disorders, healthy controls, prodromal conditions, and mutation carriers.Results:In the Parkinson’s Progression Marker Initiative cohort, mean baseline serum neurofilament light chain was higher in Parkinson’s disease patients (13 ± 7.2 pg/mL) than in controls (12 ± 6.7 pg/mL), P = 0.0336. Serum neurofilament light chain increased longitudinally in Parkinson’s disease patients versus controls (P < 0.01). Motor scores were positively associated with neurofilament light chain, whereas some cognitive scores showed a negative association.Conclusions:Neurofilament light chain in serum samples is increased in Parkinson’s disease patients versus healthy controls, increases over time and with age, and correlates with clinical measures of Parkinson’s disease severity. Although the specificity of neurofilament light chain for Parkinson’s disease is low, it is the first blood-based biomarker candidate that could support disease stratification of Parkinson’s disease versus other cognate/neurodegenerative disorders, track clinical progression, and possibly assess responsiveness to neuroprotective treatments. However, use of neurofilament light chain as a biomarker of response to neuroprotective interventions remains to be assessed.

Postural Body Sway as Surrogate Outcome for Myelopathy in Adrenoleukodystrophy.

BackgroundMyelopathy is the core clinical manifestation of adrenoleukodystrophy (ALD), which is the most common peroxisomal disorder. Development of therapies requires sensitive and clinically relevant outcome measures. Together with spastic paraparesis, balance disturbance is the main cause of disability from myelopathy in ALD. In this cross-sectional study, we evaluated whether postural body sway – a measure of balance – could serve as a surrogate outcome in clinical trials.MethodsForty-eight male ALD patients and 49 age-matched healthy male controls were included in this study. We compared sway amplitude and sway path of ALD patients to controls. We then correlated the body sway parameters showing the largest between-group differences with clinical measures of severity of myelopathy. To correct for age, we performed multiple linear regression analysis with age and severity of myelopathy as independent variables.ResultsAll body sway parameters were significantly higher in patients than in controls, with medium to large effect sizes (r = 0.43–0.66, p < 0.001). In the subgroup of asymptomatic patients, body sway amplitude was also higher, but the difference with controls was smaller than for symptomatic patients (effect size r = 0.38–0.46). We found moderate to strong correlations between body sway amplitude and clinical severity of myelopathy (r = 0.40–0.79, p < 0.005). After correction for age, severity of myelopathy was a significant predictor of body sway amplitude in all regression models.ConclusionsThese results indicate that postural body sway may serve as a surrogate outcome for myelopathy in ALD. Such outcomes are important to evaluate new therapies in clinical trials. Further longitudinal studies are needed and ongoing in this cohort.

Vascular Inflammation Is a Risk Factor Associated with Brain Atrophy and Disease Severity in Parkinson's Disease: A Case-Control Study.

Introduction Systemic inflammation with elevated oxidative stress causing neuroinflammation is considered a major factor in the pathogenesis of Parkinson's disease (PD). The interface between systemic circulation and the brain parenchyma is the blood-brain barrier (BBB), which also plays a role in maintaining neurovascular homeostasis. Vascular cell adhesion molecule-1 (VCAM-1) and microRNAs (miRNAs) regulate brain vessel endothelial function, neoangiogenesis, and, in turn, neuronal homeostasis regulation, such that their dysregulation can result in neurodegeneration, such as gray matter atrophy, in PD. Objective Our aim was to evaluate the associations among specific levels of gray matter atrophy, peripheral vascular adhesion molecules, miRNAs, and clinical disease severity in order to achieve a clearer understanding of PD pathogenesis. Methods Blood samples were collected from 33 patients with PD and 27 healthy volunteers, and the levels of VCAM-1 and several miRNAs in those samples were measured. Voxel-based morphometry (VBM) analysis was performed using 3 T magnetic resonance imaging (MRI) and SPM (Statistical Parametric Mapping software program). The associations among the vascular parameter, miRNAs, gray matter volume, and clinical disease severity measurements were evaluated by partial correlation analysis. Results The levels of VCAM-1, miRNA-22, and miRNA-29a expression were significantly elevated in the PD patients. The gray matter volume atrophy in the left parahippocampus, bilateral posterior cingulate gyrus, fusiform gyrus, left temporal gyrus, and cerebellum was significantly correlated with increased clinical disease severity, the upregulation of miRNA levels, and increased vascular inflammation. Conclusion Patients with PD seem to have abnormal levels of vascular inflammatory markers and miRNAs in the peripheral circulation, and these levels are correlated with specific brain volume changes. This study reinforces the associations among peripheral inflammation, the BBB interface, and gray matter atrophy in PD and further demonstrates that BBB dysfunction with neurovascular impairment may play an important role in PD progression.

Metrics extracted from a single wearable sensor during sit-stand transitions relate to mobility impairment and fall risk in people with multiple sclerosis

BackgroundApproximately half of the 2.3 million people with multiple sclerosis (PwMS) will fall in any three-month period. Currently clinicians rely on self-report measures or simple functional assessments, administered at discrete time points, to assess fall risk. Wearable inertial sensors are a promising technology for increasing the sensitivity of clinical assessments to accurately predict fall risk, but current accelerometer-based approaches are limited. Research questionWill metrics derived from wearable accelerometers during a 30-second chair stand test (30CST) correlate with clinical measures of disease severity, balance confidence and fatigue in PwMS, and can these metrics be used to accurately discriminate fallers from non-fallers? MethodsThirty-eight PwMS (21 fallers) completed self-report outcome measures then performed the 30CST while triaxial acceleration data were collected from inertial sensors adhered to the thigh and chest. Accelerometer metrics were derived for the sit-to-stand and stand-to-sit transitions and relationships with clinical metrics were assessed. Finally, the metrics were used to develop a logistic regression model to classify fall status. ResultsAccelerometer-derived metrics were significantly associated with multiple clinical metrics that capture disease severity, balance confidence and fatigue. Performance of a logistic regression for classifying fall status was enhanced by including accelerometer features (accuracy 74%, AUC 0.78) compared to the standard of care (accuracy 68%, AUC 0.74) or patient reported outcomes (accuracy 71%, AUC 0.75). SignificanceAccelerometer derived metrics were associated with clinically relevant measures of disease severity, fatigue and balance confidence during a balance challenging task. Inertial sensors could feasibly be utilized to enhance the accuracy of functional assessments to identify fall risk in PwMS. Simplicity of these accelerometer-based metrics could facilitate deployment for community-based monitoring.

Cannabis use the week before admission to psychiatric in-patient service as a marker of severity

ObjectiveTo evaluate if cannabis dose recorded as standard joint unit (SJU) consumed before admission and other related factors have an influence on psychiatric inpatient's symptom severity and clinical outcomes. MethodsCross-sectional study in an acute psychiatric inpatient unit including 106 individuals. Quantity of cannabis was measured as SJU and symptoms severity through the Brief Psychiatric Rating Scale (BPRS). Secondary outcomes (e.g. length of stay) were also assessed. Bivariate analyses and multivariate analyses were performed to determine the effect of SJU consumed before admission on measures of clinical severity. ResultsPoint prevalence of cannabis use before admission was 25.5%. Mean BPRS score was 55.8 (SD = 16.1); and 62.9 (SD = 11.1) among cannabis users. A low degree positive correlation between SJU consumed the week before admission and BPRS score (rs = 0.28, p = 0.03) was found. In the multivariate analyses both main diagnostic group, Schizophrenia and other psychotic disorders vs. others (Bipolar and Unipolar Affective Disorders and Addictive disorders) (B = 8.327; 95% CI 4.976–11.677) and need of PRN (“pre re nata” or when necessary) administration of antipsychotics and benzodiazepines (B = 12.13; 95% CI 6.868–17.393) were significant predictors, both increasing BPRS score. ConclusionsThe study did not find a correlation between SJU consumed last week and psychiatric severity. On the other hand, individuals with psychotic disorders reported a higher prevalence of cannabis use the week before admission and displayed higher BPRS scores, which points to the need for the development of tailored interventions for high-risk groups. The SJU is a useful quantification tool suitable for further clinical research.

Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Testing Positive for Coronavirus Disease 2019 (COVID-19)

The role of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) in the setting of the coronavirus disease 2019 (COVID-19) pandemic is hotly debated. There have been recommendations to discontinue these medications, which are essential in the treatment of several chronic disease conditions, while, in the absence of clinical evidence, professional societies have advocated their continued use. To study the association between use of ACEIs/ARBs with the likelihood of testing positive for COVID-19 and to study outcome data in subsets of patients taking ACEIs/ARBs who tested positive with severity of clinical outcomes of COVID-19 (eg, hospitalization, intensive care unit admission, and requirement for mechanical ventilation). Retrospective cohort study with overlap propensity score weighting was conducted at the Cleveland Clinic Health System in Ohio and Florida. All patients tested for COVID-19 between March 8 and April 12, 2020, were included. History of taking ACEIs or ARBs at the time of COVID-19 testing. Results of COVID-19 testing in the entire cohort, number of patients requiring hospitalizations, intensive care unit admissions, and mechanical ventilation among those who tested positive. A total of 18 472 patients tested for COVID-19. The mean (SD) age was 49 (21) years, 7384 (40%) were male, and 12 725 (69%) were white. Of 18 472 patients who underwent COVID-19 testing, 2285 (12.4%) were taking either ACEIs or ARBs. A positive COVID-19 test result was observed in 1735 of 18 472 patients (9.4%). Among patients who tested positive, 421 (24.3%) were admitted to the hospital, 161 (9.3%) were admitted to an intensive care unit, and 111 (6.4%) required mechanical ventilation. Overlap propensity score weighting showed no significant association of ACEI and/or ARB use with COVID-19 test positivity (overlap propensity score-weighted odds ratio, 0.97; 95% CI, 0.81-1.15). This study found no association between ACEI or ARB use and COVID-19 test positivity. These clinical data support current professional society guidelines to not discontinue ACEIs or ARBs in the setting of the COVID-19 pandemic. However, further study in larger numbers of hospitalized patients receiving ACEI and ARB therapy is needed to determine the association with clinical measures of COVID-19 severity.

Scale-free functional brain dynamics during recovery from sport-related concussion.

Studies using blood‐oxygenation‐level‐dependent functional magnetic resonance imaging (BOLD fMRI) have characterized how the resting brain is affected by concussion. The literature to date, however, has largely focused on measuring changes in the spatial organization of functional brain networks. In the present study, changes in the temporal dynamics of BOLD signals are examined throughout concussion recovery using scaling (or fractal) analysis. Imaging data were collected for 228 university‐level athletes, 61 with concussion and 167 athletic controls. Concussed athletes were scanned at the acute phase of injury (1–7 days postinjury), the subacute phase (8–14 days postinjury), medical clearance to return to sport (RTS), 1 month post‐RTS and 1 year post‐RTS. The wavelet leader multifractal approach was used to assess scaling () and multifractal () behavior. Significant longitudinal changes were identified for , which was lowest at acute injury, became significantly elevated at RTS, and returned near control levels by 1 year post‐RTS. No longitudinal changes were identified for . Secondary analyses showed that clinical measures of acute symptom severity and time to RTP were related to longitudinal changes in . Athletes with both higher symptoms and prolonged recovery had elevated values at RTS, while athletes with higher symptoms but rapid recovery had reduced at acute injury. This study provides the first evidence for long‐term recovery of BOLD scale‐free brain dynamics after a concussion.

Inside the USCAP Journals

Inside the USCAP Journals

Neuronal pentraxin 2: a synapse-derived CSF biomarker in genetic frontotemporal dementia

IntroductionSynapse dysfunction is emerging as an early pathological event in frontotemporal dementia (FTD), however biomarkers are lacking. We aimed to investigate the value of cerebrospinal fluid (CSF) neuronal pentraxins (NPTXs),...

POTENTIAL ROLE OF OSTEOCALCIN AND OSTEOPROTEGRIN IN DETERMINING THE CONNECTION BETWEEN RHEUMATOID ARTHRITIS AND PERIODONTITIS: PERSPECTIVE CASE STUDY FROM LOCAL POPULATION OF PUNJAB, PAKISTAN

Objective: The aim of this study was to determine the association between Rheumatoid Arthritis and Periodontitis with the help of biomarkers Osteocalcin and Osteoprotegerin. Materials and Methods: One hundred and twenty subjects were enrolled using consecutive nonprobability sampling for four groups, i.e., controls, clinically diagnosed cases of Rheumatoid Arthritis and Periodontitis, and both after informed consent (attached in the end). Serum Osteocalcin and Osteoprotegerin were measured along with Anti-CCP antibodies and clinical measures of severity of Periodontitis with the help of bleeding on probing (BOP), clinical attachment loss (CAL) and periodontal pocket depth (PPD). ANOVA and post hoc analysis were used to determine the difference of mean in different groups using SPSS 21. Results: Mean Osteocalcin and Osteoprotegerin were equally distributed among all four groups, although showing trends of increase and decrease in mean plots, respectively (using ANOVA, p value= 0.711, 0.15, respectively). Anti-CCP antibodies, mean CAL, mean BOP, mean PPD, and age were significantly different in four groups (p-value &lt; 0.05 for all). Gender and RA factor were homogenous in all groups (p-value &gt; 0.05 for both), i.e., there was the same number of males and females in each group, and the Rheumatoid factor was equally distributed in patients of all four groups. This proves the fact that the RA factor is just a sensitive test and not a specific test for the diagnosis of Rheumatoid Arthritis. Conclusion: It is concluded that at the current sample size of 120 subjects, i.e., 30 controls and 30 patients each in with either Rheumatoid Arthritis or Periodontitis or both, there is no difference in mean Osteocalcin and Osteoprotegerin levels.

Tic frequency and behavioural measures of cognitive control are improved in individuals with Tourette syndrome by aerobic exercise training

Previous observations of improvements in cognition in typically developing children following moderate to vigorous exercise (e.g., Budde, Voelcker-Rehage, Pietrabyk-Kendziorra, Ribeiro, & Tidow, 2008; Hillman et al., 2009) have led to increased interest in the potential benefits of exercise for children with neurodevelopmental disorders, involving difficulties in self-regulation (e.g., Halperin & Healey, 2011; Archer & Kostrzewa, 2012). Using a within-sample design, the current study looked at the beneficial effects of non-aerobic movement training (Tai Chi), compared to aerobic movement training (Kick Boxing), on behavioural measures of cognitive control and clinical measures of tic severity in a group of young people with Tourette Syndrome (TS). We demonstrate that Kick Boxing, but not Tai Chi, led to a significant enhancement in cognitive control task performance. Furthermore, while tic frequency (tics per minute) was reduced during both types of exercise, this reduction was significantly greater, and sustained for longer, following Kick Boxing. Importantly, the magnitude of the increase in cognitive control following Kick Boxing predicted the degree of reduction in tic frequency. These findings suggest that aerobic exercise may be a useful intervention for improving self-regulation of tics in young people with TS, probably through enhancements in associated cognitive control circuits.