Nonparametric Research Articles

EVALUATING THE LATERALITY OF MARTIAL ARTS PRACTITIONERS THROUGH THE KINEMATIC ANALYSIS OF STRIKING TECHNIQUES

The purpose of this study was to objectively measure and highlight laterality differences of high-performance martial arts athletes with hitting techniques and comparing the results registered by each subject. The hypothesis of this research is that through kinematic analysis on both fighting stances (dominant and non-dominant) we can highlight the differences in laterality for each subject. We used a system of inertial measurement units based on 17 motion tracking sensors composed of 3D gyroscopes, 3D accelerometers and 3D magnetometers namely the MVN Xsens Awinda system. We acquisitioned data from 8 high-performance athletes practicing martial arts with hitting techniques. We calculated and analyzed kinematic parameters for some of the most frequently used techniques in this category of martial arts, more specific direct and circular kicks. In order to obtain information related to the level of laterality of the monitored athletes, we compared the values of these parameters for the technical executions on the dominant and non-dominant side and highlighted the significant differences through the Wilcoxon Signed Rank nonparametric significance test. To facilitate comparisons between subjects in terms of laterality, we drew up an original evaluation scale and created diagrams based on the scores obtained by them. Based on these evaluations, directing and individualizing training and choosing combat tactics can be made much more informed.

The Effect Of Virginia Coconut Oil (VCO) On The Prevention Of Decubitus In Prolonged Bed Rest Patients

Decubitus is a condition where external pressure causes damage or injury to local tissue. Trauma and surgical wounds can cause damage to skin integrity, long-term pressure on the skin can also cause irritation and the formation of decubitus, People who experience nerve damage due to stroke, traumatic injury, diabetes mellitus, or coma are also more likely to experience decubitus. The purpose of this study was to determine the effect of administering virgin coconut oil (VCO) on the risk of decubitus. The research method used the Pre Experiment design method with a one group pre post test design. The population in this study were all patients in the Akasia Inpatient Room, Siti Fatimah Az-Zahra Hospital, South Sumatra Province. The total number of patients treated was 30 respondents. Sampling was carried out using the total sampling technique. The results of the study showed that there was an effect of administering virginia coconut oil on the risk of decubitus in patients with long-term bed rest, the significant value of the non-parametric statistical test (Wilcoxon) was 0.000 (p value 0.000 <0.05). Suggestions are expected as input and sources of information in providing counseling to patients who are bedridden for a long time to use pharmacological therapy in preventing decubitus, and routinely use Virginia Coconut Oil which has many benefits.

Modeling the distribution of jet fuel price returns based on fat-tail stable Paretian distribution.

Jet fuel plays a crucial role as an essential energy source in aerospace and aviation operations. The recent increase in fuel prices has presented airlines with the new challenge of managing jet fuel costs to ensure consistent cash flow and minimize operational uncertainties. The conventional risk prediction models used by airlines often assume that risks are normally distributed according to the classical Central Limit Theorem, which can lead to under-hedging. This paper proposes an innovative approach using the stable Paretian model to analyze the price return of jet fuel in large samples. It comprehensively compares the fitting effect of the stable Paretian distribution with that of the normal distribution based on specific criteria and non-parametric significance tests. Furthermore, it investigates the accuracy of risk measures such as Value at Risk (VaR) and Conditional Value at Risk (CVaR) predicted by both models. In addition to comparing differences in VaR between predicted values and actual values, this paper provides a more comprehensive comparison of risk measures under rolling window forecast situation. Results suggest that despite indistinguishable results in VaR backtest, the stable Paretian distribution has a overall better fitting effect as well as a less biased predicted CVaR based on the AIC of -14099.46, BIC of -14110.98, p = 0.58 in Kolmogorov-Smirnov test and p = 0.46(0.92) in the 0.01(0.05) significance level of Expected Shortfall Regression Test. This might be explained by its ability to capture asset return dynamics while maintaining shape stability with few parameters. This research can provide valuable insights for guiding airlines' risk management decisions. its ability to capture asset return dynamics while maintaining shape stability with few parameters. This research can provide valuable insights for guiding airlines' risk management decisions.

Antibacterial potential of queen pineapple (Ananas comosus (L.) Merr Var. Queen) peel extract on the growth of Lactobacillus acidophilus bacteria

Based on the Global Burden of Disease Study in 2017, the prevalence of caries in each country reached 20% to more than 50%. Caries is formed due to the role of several factors including host, agent (microorganisms), substrate, and time. Bacteria involved in the origin of caries formation such as Lactobacillus group bacteria found in the oral cavity which can cause dental caries, one of which is Lactobacillus acidophilus. The use of natural cleansers is highly recommended to remove residual bacteria as an effort to prevent caries. Queen Pineapple (Ananas comosus (L.) Merr Var. Queen) is a fruit that contains very complex compounds that can act as anticarcinogenic and antibacterial. This study aims to determine the Minimum Bactericidal Concentration (MBC) and Minimum Inhibitory Concentration (MIC) against the growth of Lactobacillus acidophilus bacteria. This type of research was a laboratory experimental type with posttest only control group design. This study used the dilution method of the number of samples, namely concentrations of 0.781%, 1.56%, 3.125%, 6.25%, 12.5%, 25%, 50%, 100%, positive controls and negative controls. This study was conducted 3 times repetition. Manual calculation of the number of bacterial colonies that grow on nutrient agar media and expressed in colony forming units (CFU) which will determine the MBC and MIC. The Shapiro-Wilk test showed a p value> 0.05 at all concentrations and normally distributed data, but when tested for homogeneity the data was not homogeneous so that the non-parametric statistical test continued using the Kruskal Wallis test showing a value of p < 0.05. Conclusion: Colony count results showed that the concentration of 3.12% can inhibit the visible growth of Lactobacillus acidophilus bacteria which is stated as the Minimum Inhibitory Concentration (MIC) and can prevent growth after subculture to antibiotic-free medium at a concentration of 6.25% which is stated as the Minimum Bactericidal Concentration (MBC).

From hardware to software integration: A comparative study of usability and safety in vehicle interaction modes

The increasing advancement of human–machine interaction (HMI) technology has brought the modes of vehicle HMI into focus, as they are closely related to driver and passenger safety and directly affect the travel experiences. This study compared the usability and safety of three vehicle HMI modes: hardware interaction (HI), hardware and software interaction (HSI), and software interaction (SI). The evaluation comprised two dimensions: usability and safety. Sixty participants’ performance on these tasks was evaluated at two driving speeds (30 km/h and 60 km/h). The results of the nonparametric tests indicated significant differences between the three interaction modes: (1) HI was the highest safety-oriented interaction mode with participants had the highest average vehicle speed and maximum acceleration measured at 60 km/h and the lowest glance frequency at both speeds; (2) HSI was the most usable interaction mode. Participants had the shortest task-completion time measured at 60 km/h and the highest score on the NASA-TLX and SUS scales taken for both speeds; (3) SI was the lowest secure and usable in-vehicle interaction mode. Participants had the longest task-completion time at 60 km/h, the highest error frequency under 30 and 60 km/h and the highest glance frequency, the longest total glance duration and the longest average glance time. In conclusion, HI and HSI were more secure and usable in-vehicle interaction modes than SI. From a theoretical exploration perspective, this paper elaborates on some exploratory thoughts and innovative ideas for practical application to the screen HMI mode selection and design in intelligent vehicle cabins.

Results of bracing adolescent idiopathic scoliosis in the context of clinical practice and the Scoliosis Research Society’s criteria: 5-year observational study from a German orthopaedic university hospital

BackgroundBrace therapy’s influence on adolescent idiopathic scoliosis’s (AIS) natural course is inconclusive.MethodsBrace-treated AIS patients from 2016 to 2020 were examined regarding four endpoints at brace weaning: surgery need, curve progress ≥ 6° and > 45°, and curve improvement ≥ 6°. Prediction variables’ influence was computed for the all-patients group and three subgroups (Subgroup 1: fulfilling the Scoliosis Research Society’s [SRS] criteria, Subgroup 2: initial Cobb angle < 25°, Subgroup 3: initial Cobb angle > 40°). According to the data characteristics, parametric and non-parametric tests and binary logistic regression were performed.ResultsThe research included 69 patients. Overall, after brace weaning surgery was recommended for 20.3% of them, curve progression was ≥ 6° in 23.2%, the Cobb angle was beyond 45° in 11.6%, and the Cobb angle improved by ≥ 6° in 20.3%. Patients needing surgery had a significantly higher initial Cobb angle (38.8° ± 9.8° vs 27.8° ± 7.6°, p < 0.001), lower Risser stages (p = 0.010), and higher Nash and Moe degrees (p = 0.030). Patients with curve progress ≥ 6° were younger at first curve notification (12.4 ± 1.5 vs 13.7 ± 1.7 years, p = 0.011) and older at menarche (13.4 ± 1.1 vs 12.6 ± 1.2 years, p = 0.037). Furthermore, 21.6% of all Risser 3 and 4 patients had still curve progress ≥ 6°. In-brace correction was significantly higher in patients with curve improvement ≥ 6° vs < 6° (54.0% ± 31.2% vs 31.9% ± 30.7%; p = 0.019). Nine patients fulfilled the SRS criteria, 22 had initial Cobb angles < 25°, and 11 had > 40°. Real brace wear (RBW) in all groups had no significant effect on outcome. Two significant subgroup differences were found: Surgery recommendation and curve progression beyond 45° were significantly more frequent in the initial Cobb angle > 40° subgroup.ConclusionsBrace effectiveness can be assumed because curve improvement was achieved in nearly one-fifth with sufficient in-brace correction. However, no significant influence of RBW on the outcome endpoints was demonstrated. To clarify conflicting results, big data management, including untreated patients, must be employed to further research AIS’s multifactorial influenced aetiology and course. Meanwhile, it is worth starting bracing in AIS in practice also beyond the SRS’s criteria.

Exploring mitochondrial blood-based and genetic markers in older adults with mild cognitive impairment and remitted major depressive disorder

Mild cognitive impairment (MCI) is a prodromal stage in aging to possible progression to Alzheimer’s disease and related dementia (ADRD), where co-occurrence of major depressive disorder (MDD) accelerates the progression. Metabolic and mitochondrial abnormalities in ADRD and other neurodegenerative disorders have been widely suggested, while possible mitochondrial dysfunction has been associated with etiopathology of both MCI and MDD. Hence, investigation of mitochondrial markers in MCI, MDD, and presence of both conditions is warranted. In total, 332 older adult participants were included: 168 with MCI, 108 with MCI plus remitted MDD (rMDD), and 56 with rMDD but without MCI. We measured plasma circulating mitochondrial DNA (ccf-mtDNA), lactate, and extracted nuclear mitochondrial encoded (NMt) single-nucleotide variants (SNVs) (n = 312). Non-parametric statistical tests on ccf-mtDNA and lactate levels were performed on the diagnosis, clinical and cardiometabolic variables. Binary sequence kernel association test (SKAT-O) and burden test were performed on NMt-SNV, adjusted for age, race, gender, type II diabetes, and APOE genotype. Lower level of lactate was observed in MCI (KW χ2 = 14.8, P = 0.0024), more specifically, significant differences of lower plasma lactate between MCI only and rMDD, but not between MCI+rMDD and MCI were found, suggesting potential roles in MCI driving lactate lower levels. While higher levels of ccf-mtDNA were observed in APOE-ε4 carrier (χ2 = 5.04, P = 0.05). This relationship was present only in MCI (P = 0.043) and MCI+rMDD groups (P = 0.023). No significant nuclear-encoded mitochondrial gene associations were observed with MCI or MDD. The results suggest decreased level of plasma lactate in individuals with MCI and MCI+rMDD, with inverse correlation with ccf-mtDNA, in addition to effect of APOE-ε4 in further increasing ccf-mtDNA specifically in participants with cognitive impairment. These findings contribute to a deeper understanding of the mitochondrial markers in MCI and MDD, warranting further research to explore the precise roles of mitochondrial abnormalities in the development and progression of MCI.

Assessment of cardiac and skeletal muscle metabolites using 1H-MRS and chemical-shift encoded magnetic resonance imaging: Impact of diabetes, RAGE, and DIAPH1.

Diabetes affects metabolism and metabolite concentrations in multiple organs. Previous preclinical studies have shown that receptor for advanced glycation end products (RAGE, gene symbol Ager) and its cytoplasmic domain binding partner, Diaphanous-1 (DIAPH1), are key mediators of diabetic micro- and macro-vascular complications. In this study, we used 1H-Magnetic Resonance Spectroscopy (MRS) and chemical shift encoded (CSE) Magnetic Resonance Imaging (MRI) to investigate the metabolite and water-fat fraction in the heart and hind limb muscle in a murine model of type 1 diabetes (T1D) and to determine if the metabolite changes in the heart and hind limb are influenced by (a) deletion of Ager or Diaph1 and (b) pharmacological blockade of RAGE-DIAPH1 interaction in mice. Nine cohorts of male mice, with six mice per cohort, were used: wild type non-diabetic control mice (WT-NDM), WT-diabetic (WT-DM) mice, Ager knockout non-diabetic (RKO-NDM) and diabetic mice (RKO-DM), Diaph1 knockout non-diabetic (DKO-NDM), and diabetic mice (DKO-DM), WT-NDM mice treated with vehicle, WT-DM mice treated with vehicle, and WT-DM mice treated with RAGE229 (antagonist of RAGE-DIAPH1 interaction). A Point Resolved Spectroscopy (PRESS) sequence for 1H-MRS, and multi-echo gradient recalled echo (GRE) for CSE were employed. Triglycerides, and free fatty acids in the heart and hind limb obtained from MRS and MRI were compared to those measured using biochemical assays. Two-sided t-test, non-parametric Kruskal-Wallis Test, and one-way ANOVA were employed for statistical analysis. We report that the results were well-correlated with significant differences using MRI and biochemical assays between WT-NDM and WT-DM, as well as within the non-diabetic groups, and within the diabetic groups. Deletion of Ager or Diaph1, or treatment with RAGE229 attenuated diabetes-associated increases in triglycerides in the heart and hind limb in mice. These results suggest that the employment of 1H-MRS/MRI is a feasible non-invasive modality to monitor metabolic dysfunction in T1D and the metabolic consequences of interventions that block RAGE and DIAPH1.

Evaluation of the positional reproducibility of sedation versus non-sedation state in pediatric radiotherapy: a retrospective study.

To assess the positional reproducibility of sedated and non-sedated pediatric tumor patients during radiotherapy through a retrospective analysis of cone-beam computed tomography (CBCT) and planned computed tomography (CT) scan data. The positional reproducibility of 40 pediatric tumor patients, aged 2 to 17 years with a median age of 4.5 years, who received radiotherapy under sedated and non-sedated states was retrospectively compared. The first CBCT images obtained during CT-based treatment planning were analyzed. The analysis encompassed six-dimensional positional changes, including vertical (Vrt), longitudinal (Lng), lateral (Lat), rotational (Rtn), pitch, and roll directions. Kolmogorov-Smirnov Z nonparametric rank-sum testing was employed to evaluate the positional deviations, considering absolute values regardless of directionality. Data were further stratified based on different fixation methods used during treatment. Sedated patients exhibited significantly smaller positional deviations in Vrt, Lng, Lat, and Rtn directions in the body membrane group compared with their non-sedated counterparts (P<0.05). Similarly, sedated patients demonstrated reduced positional deviations in Vrt, Lng, Lat, Rtn, pitch and Roll directions in the head and neck group compared with non-sedated patients (P<0.05). Meanwhile, compared with vacuum bag plus body membrane fixation, the head and shoulder film fixation technique proved superior in terms of positional reproducibility during sedated treatment, specifically in Vrt, Lng, Lat, Pitch, and Roll directions (P<0.05). Similarly, compared with the alternative fixation method, the head and shoulder film fixation method showed better positional deviations in six-Dimensional directions in non-sedated patients (P<0.05). While sedated radiotherapy may offer advantages in terms of positional reproducibility, the present study underscores the importance of considering non-sedated radiotherapy as a viable option for pediatric tumor patients. Non-sedated treatment not only provides effective tumor control but also mitigates the psychological trauma and long-term side effects associated with repeated sedative drug use. Future studies should further explore the optimal sedation and fixation strategies for pediatric radiotherapy.

Low Iron Diet Improves Clinical Arthritis in the Mouse Model of Collagen-Induced Arthritis.

Background: In response to inflammation, the absorption of nutritional iron is restricted. Since the pathophysiological significance of the presence and uptake of iron in chronic inflammation is still unknown, we tested the effect of a low iron diet on the clinical course of arthritis in the mouse model of collagen-induced arthritis (CIA). Methods: Six- to eight-week-old male DBA/1 mice were fed either a normal (51 mg/kg) or a low iron diet (5 mg/kg) starting four weeks before the first immunization. From day 4 after the second collagen booster made on day 25, the development of arthritis was regularly monitored until the end of the experiment (day 34), using a standard clinical arthritis score. Concentrations of mouse anti-bovine and anti-mouse collagen type 2 IgG antibodies were measured by ELISA; blood cell counts were performed and mediators of inflammation, tissue matrix degradation, oxygenation and oxidative stress were measured in the mouse sera of both diet groups at the end of the experiment by bead-based multiplex assay. Fe2+, Fe3+, oxidized and reduced glutathione (GSH and GSSG) and malondialdehyde (MDA) were quantified in whole paw tissue by ELISA. Quantitative PCR was performed in the tissues for glutathione peroxidase 4 and other key regulator genes of iron metabolism and ferroptosis. We used nonparametric tests to compare cross-sectional data. Nonlinear regression models were used for longitudinal data of the arthritis scores. Results: Mice fed a low iron diet showed a significantly less severe course of arthritis compared to mice fed a normal iron diet (p < 0.001). The immune response against bovine and mouse type 2 collagen did not differ between the two diet groups. Mice fed a low iron diet exhibited significantly lower serum levels of tissue inhibitor of metalloproteinase-1 (TIMP-1), a central regulator of inflammation and tissue matrix degradation (p < 0.05). In addition, a low iron diet led to a significant reduction in red blood cell indices, indicating restricted iron uptake and latent iron deficiency, but had no effect on hemoglobin concentrations or red blood cell counts. There were no differences between the dietary groups in Fe2+ or Fe3+ content in the paws. Based on calculation of the GSH/GSSG ratio and high MDA levels, high oxidative stress and lipid peroxidation were likewise detected in the paws of both diet groups of mice. Consequently, no differences associated with gene expression of key regulators of iron metabolism and ferroptosis could be detected between the paws of both diet groups. Conclusions: Restricted dietary iron intake alleviates immune-mediated inflammation in CIA without causing anemia. This finding suggests a promising option for dietary treatment of arthritis in inflammation. The underlying mechanism causing reduced arthritis may be linked to the complex regulatory network of TIMP-1 and appears to be independent from the local iron levels, oxidative stress and ferroptosis in the synovial tissues.

The role of early orthotic intervention in the management of post-traumatic elbow contractures: Study protocol for phase II double-blinded randomised controlled trial.

Restoration of full elbow extension following trauma is difficult and influenced by the injury profile, surgeon preference, patient and environmental factors. The literature suggests that orthotic interventions are effective in improving contractures when movement plateaus despite normal therapeutic interventions. It is not known if extension orthotic intervention is more superior to standard treatment regardless of when it is commenced. The literature lacks patient-reported considerations to contracture management using elbow orthoses. This protocol describes a Phase II double blinded randomised controlled feasibility trial (RCT) and mixed methods study, aimed to examine outcome with extension in an orthotic intervention group (OG) versus control (CG). All participants will undergo six weekly therapy sessions, which include a standardised therapeutic program. OG participants will be provided with an additional extension orthosis and the outcome is assessed according to the change in elbow extension motion after 6 weeks of intervention. Data will be collected via questionnaires, logbooks, feedback forms, and semi-structured interviews at baseline and final assessments for descriptive statistical analysis. Under the guidance of a statistician, all quantitative data will be evaluated using the appropriate parametric or non-parametric analyses to evaluate for systematic differences between groups. Preliminary extension gains are used to determine the final sample size required to achieve adequate power for a full-scaled RCT. Interview data on OG participants will be qualitatively analysed using the "five-factorial dimensions of adherence" framework to identify key differences in the influencers between adherent or non-adherent groups. ANZCTR ACTRN12619001402134p.

Comparison of a customized glycemic pellets challenge with the oral sugar test to measure glycemic and insulinemic responses in horses.

Testing for insulin dysregulation (ID) in horses is commonly performed to guide management and therapeutic strategies. To evaluate a newly developed glycemic pellets challenge (GPC) and compare results to those obtained using the low-dose oral sugar test (OST). Twenty-four adult horses with unknown insulin status. A randomized crossover trial was performed. Horses underwent GPC (0.5 g glycemic carbohydrates/kg body weight) and OST (0.15 mL corn syrup/kg body weight) 7 days apart. Feed was withheld before testing and blood samples were collected at T0, T60, T120, and T180 minutes for GPC and at T0, T60, and T90 minutes for OST. Blood glucose concentration was measured using a point-of-care glucometer and insulin by radioimmunoassay. Comparisons were made using nonparametric tests, linear regression, and Bland-Altman agreement analysis. Eighteen horses consumed >85% of the GPC pellets within 10 minutes and had acceptable OST results. Maximum glucose (P = .02) and insulin (P = .007) concentrations were significantly higher for GPC compared with OST. Time to maximum insulin concentration (Tmax[ins]) varied within and between tests and neither Tmax[ins] (P = .28) nor maximum insulin concentration (P = .46) was correlated with the time horses took to consume pellets. The GPC is well tolerated and may offer another diagnostic testing modality for ID. Blood glucose and insulin concentrations increase during GPC and reach higher concentrations than observed with low-dose OST. The Tmax[ins] varied for GPC and OST, emphasizing the importance of identifying the optimal time range for the collection of samples to capture diagnostically relevant changes in insulin concentration.

Caffeine intake, chronotype, and student sleep quality at Polytechnic of Leiria

Abstract Introduction Higher education students ingest very high doses of caffeine, on average twice the recommended safe dose. This excessive consumption can become problematic, ultimately affecting sleep quality and, consequently, academic performance. The aim of this work is to describe caffeine consumption, sleep quality and to characterize the chronotype and academic performance of students at Polytechnic of Leiria. Methods An online self-completion questionnaire was developed, consisting of several instruments: The Caffeine Consumption Questionnaire; Horne and Ostberg morningness-eveningness Questionnaire; Pittsburgh Sleep Quality Index (PSQI), to describe caffeine consumption, characterize chronotype and assess sleep quality, respectively. The mean, standard deviation, minimum and maximum values were calculated for the quantitative variables. Absolute and relative frequencies were calculated for the qualitative variables. Parametric tests were used to compare groups; when this was not possible, non-parametric tests were used. P &amp;lt; 0.05 was considered statistically significant. Results Of the 261 students (mean age: 23.26 ± 6.60 years), 64.2% had poor sleep quality and 45.3% reported an afternoon chronotype. It was found that men consumed more coffee and energy drinks than women, although women consumed more caffeine-containing food products. The average academic score was 14.56 ± 1.61. There was a statistically significant association (p &amp;lt; 0.01) between the afternoon chronotype and poor sleep quality and between the consumption of coffee and chocolate drinks and poor sleep quality. Conclusions Students at Polytechnic of Leiria tend to have poor sleep quality and an intermediate chronotype. Those with an afternoon chronotype or who drink coffee and chocolate drinks have poor sleep quality. Key messages • Accurately assessing the situation is essential for crafting suitable solutions. • Higher students should adjust their coffee consumption to achieve better sleep quality.

Induction and maturation of somatic embryogenesis in mangaba tree a multipurpose Apocynaceae

This study reported the first results of in vitro somatic embryogenesis induction in Hancornia speciosa Gomes (mangaba tree, Apocynaceae). To induce callus, the TC accession leaf and nodal segments were cultivated in culture medium I (Murashige and Skoog; MS salts, putrescine, 45 µM 2,4-dichlorophenoxyacetic acid; 2,4-D and 22.19 µM 6-benzylaminopurine; BA). For the next stage (multiplication), the callus masses were sub-cultured into a culture medium II (MS salts, 22.62 µM 2,4-D and 22.19 µM BA). After 90 days, embryogenic calluses were inoculated to somatic embryo maturation medium culture III (MS salts, polyethylene glycol; PEG (0 and 2%) and BA (44.39 and 66.58 µM). Pro-embryos and somatic embryos in the maturation stage were assessed after 60 days. The rstatix package from R software with non-parametric tests (p &lt; 0.05) were used to analysis data of experiments I and II. The Tukey’s test (p &lt; 0.05) was performed on the data of experiment III. To induce and multiply embryogenic callus, 45 µM 2,4-D and 22.19 µM BA were efficient. More pro- and somatic embryo development were seen in the nodal explant cultured in the presence of 44.39 and 66.58 µM BA and 2% PEG. Putrescine does not promote the embryogenic masses of callus derived from leaf explants in the TC accession. Keywords: Hancornia speciosa Gomes, micropropagation, somatic embryo.

Intraindividual variability in lipoprotein(a): the value of a repeat measure for reclassifying individuals at intermediate-risk

Abstract Background Lipoprotein(a) [Lp(a)] is an independent risk factor for cardiovascular disease and outcomes. Levels are predominantly genetically determined and repeat measurements are traditionally considered unlikely to be useful. However, the temporal variation of Lp(a) is not well characterized and it is unclear whether a single measure of Lp(a) is sufficient to assess cardiovascular risk in all individuals. Purpose To determine the intraindividual variability of Lp(a) and whether a repeated measure reclassified Lp(a)-specific cardiovascular risk using the European Atherosclerosis Society (EAS) consensus statement risk categories. Methods This retrospective cohort study analyzed initial and repeated Lp(a) measures obtained using the same laboratory assay from 609 individuals in the Nashville Biosciences database accessed through the American Heart Association Precision Medicine Platform. Categorical variables are presented as counts (%) and compared using Fisher’s exact test. Continuous variables are presented as mean ± standard deviation or median (Q1-Q3), tested for normality using the Shapiro-Wilk test, and compared using parametric and nonparametric tests where appropriate. The Spearman’s Rank correlation coefficient was used to assess the relationship between two variables. The significance level was set at p&amp;lt;0.05. Results Median age was 52.5 (37.1-62.8) years, 45% were women, 80.3% were White patients, 13.3% were Black patients, 1.6% were Asian patients, and 4.8% were other/unknown patients. In terms of relevant comorbidities, 41% had ischemic heart disease, 24.1% had chronic kidney disease, and 13.5% had liver disease. The median time between the two Lp(a) measures was 1.07 (0.5-2.1) years. Our analysis shows a significant difference between the paired Lp(a) values (p&amp;lt;0.05), with 38.1% [95% CI 34.2%-42%] changing by ≥10mg/dL, and 40.5% [95%CI 36.6%-44.3%] changing by &amp;gt;25%. There was a positive correlation between the baseline Lp(a) levels and the absolute changes in Lp(a), (r=0.59, p&amp;lt;0.01). The proportions of individuals with variability are similar in those who were never on the potentially Lp(a)-altering agents (statin, niacin, or PCSK9 inhibitor drugs) (n=91), with 32% [95%CI 22.4%-41.6%] changing by ≥10mg/dL, and 34% [95%CI 24.3%-43.7%] changing by &amp;gt;25%. While over 90% of those whose values were initially in the EAS low-risk and high-risk categories remained in those categories, 53% of those in the intermediate "grey-zone" category transitioned to either the low (20%)- or the high (33%)- risk category (Figure). Conclusion(s) Temporal-related changes in Lp(a) variability were present in many individuals and should be included in calculating the expected effect sizes in future studies targeting Lp(a). A repeat Lp(a) measure may allow more precise Lp(a)-specific cardiovascular risk prediction for individuals whose initial value is in the EAS-defined intermediate "grey-zone" category.

COVID-19 premature mortality in Serbia: Does the place of death matter?

Abstract Background The COVID-19 pandemic has significantly impacted healthcare services provision in Serbia and globally. Many people did not seek or reach healthcare due to various reasons, and a significant number of COVID-19 deaths were not confirmed by laboratory testing. Within the project of the Laboratory for Strengthening Capacity and Performance of Health System and Workforce for Health Equity, we assessed the differences in years of life lost (YLL) of COVID-19 death cases according to the place of death. Methods The Statistical Office of the Republic of Serbia provided average life expectancy and anonymous individual mortality data of the Serbian population in 2020, 2021, and 2022, where COVID-19 was the underlying cause of death (ICD-X codes: laboratory confirmed - U07.1 and clinically diagnosed - U07.2), also disaggregated by the place of death (at home or in a hospital). Analytical statistics and nonparametric tests were used to assess the differences in premature mortality by place of death with a significance level set at p &amp;lt; 0.05. Results In all observed years, a total of 45,632 death cases due to COVID-19 occurred (94.3% in hospital and 5.7% at home). Most COVID-19 deaths were coded as U07.1 (93.8% in hospital, 91.3% at home). An average of 12.12±7.50 YLLs was estimated per death, with a median of 11.50. There was a significant difference (p &amp;lt; 0.001) in the median number of YLLs between those who died in the hospital (11.50) and those who died at home (6.78). Furthermore, deaths occurring at home had fewer YLLs but were more frequently coded as U07.2 (p &amp;lt; 0.001). Conclusions The place of death is relevant when assessing the impact of COVID-19 on premature mortality in Serbia. On average, persons who died at home due to COVID-19 had a lower number of YLLs compared to those who died in a hospital. More research is necessary on the other factors contributing to premature mortality and inequalities in the COVID-19 burden in Serbia. Key messages • During the first three years of the COVID-19 pandemic in Serbia, 5.7% of COVID-19 deaths occurred at home, resulting in an average of 9.89 years of life lost. • The COVID-19 pandemic highlights the need to investigate deaths that occur at home and improve pandemic preparedness.

Volume-pressure loop hemodynamic characterization of pulmonary hypertension

Abstract Background Pulmonary hypertension (PH) includes a wide spectrum of pathologies with different pathological bases and a variety of clinical scenarios in which right ventricular (RV)-pulmonary artery (PA) coupling has relevant prognostic implications. Currently, diagnosis and hemodynamic severity of PH is typically based on mean pulmonary arterial pressure (mPAP), pulmonary capillary wedge pressure (PCWP), and pulmonary vascular resistance (PVR). However, this conception does not take into consideration the evolution of these parameters throughout the cardiac cycle. We hypothesized that not only the magnitude but also the dynamics over time plays an important role in RV adaptation to pressure overload (i.e., constant fixed resistances throughout the cycle will have a different impact than a fluctuating resistances). Purpose To assess PA hemodynamic patterns throughout the cardiac cycle and their association with RV remodelling, by combining right heart catheterization (RHC) and cardiac magnetic resonance imaging (CMR) data. Methods 66 patients with PH (38 women, aged 63.59±14.70years, BMI 28.49±6.21 kg.m2) who underwent RHC in the supine position with a 7.5-FrSwan-Ganz catheter under fluoroscopic guidance (37 precapillary, 17 combined pre-postcapillary, 12 isolated postcapillary PH) and CMR with flow-encoded phase-contrast sequence were included. Pressure and flow tracings at the level of the main PA were integrated to obtain volume-pressure loops throughout the cardiac cycle. The resulting patterns based on morphology (Image 1) and slope (Pattern 1 mean slope 16,11% vs Pattern 2 mean slope 10,37%) were analysed and classified into 2 groups: Pattern 1 and Pattern 2. RV end-systolic (iRVESV) and end-diastolic volumes (iRVEDV), RV ejection fraction, RV mass and presence of late gadolinium enhancement (LGE) at the RV insertion points were compared between groups using parametric and non-parametric tests. Results Patients with Pattern 1 showed significantly higher mPAP (46.03±11.62 vs. 35.77±8.10 mmHg) and iPVR (746.22±584.54 vs 319.56±306.21 dynes.s.cm-5.m2) and lower PCWP (11.8±7.6 vs 17.7±7.2 mmHg). Precapillary PH patients more frequently presented a Pattern 1 (n=27; 77.1% vs 10; 32.3%). In addition, patients with Pattern 1 had higher RV volumes (iRVEDV= 105.45±34.62 ml/m2 vs 84.22±35.0 ml/m2, p=0,002; iRVESV 65.05±27.59 ml/m2 vs 44.63±25.09 ml/m2, p=0,001), poorer RV function (RVEF 39.81±11.33% vs 48.96±10.90%; p=0,001), larger RV mass (27.95±9.46 vs 23,44±7.46 g/m2, p=0,045) and smaller left atrial size (24.18±11.47 vs 34.06±19.15 cm2, p&amp;lt;0,001) than patients with Pattern 2. The quantification of LGE was also higher in Pattern 1 as compared with Pattern 2 (5.4±2.4% vs 3.0±2.3%, p&amp;lt;0.001). Conclusion Volume-pressure loops at the level of the main PA may differentiate patterns of PA hemodynamic fluctuations that have different impact on RV performance regardless the PH severity within the wide spectrum of PH.Volume-pressure loop patterns

Using HIS administrative data for initial assessment of comorbid patients’ status (Covid-19 case)

Abstract Background Despite numerous published articles, most of the studies on COVID-19 focused on influence of clinical characteristics and treatments on severity. Yet, the epidemiological viewpoint was rarely discussed. Based on our experience with comorbid hospitalized COVID-19 patients, we aim to show that HIS administrative data can be used to identify individuals that are more prone to worse outcome thus improving patient management not only during pandemics. Methods A retrospective single-center study was conducted using archived anonymized HIS administrative data for all 8319 COVID-19 patients in the university hospital ‘Saint Marina’-Varna, Bulgaria, in the period 14/06/2020-31/12/2021. Up to 7 comorbidities per patient were registered in HIS with ICD-10 codes, used for our analyses. Non-parametric tests and logistic regression were used at α=.05, 95%CI. Results Comorbid patients were 5741(69%), 50.3% ≥69y, 52% male; 1602(27.9%) died, 64% ≥69y, 54.4% male. Deceased were older (p&amp;lt; .01) and had more comorbidities (p&amp;lt; .01). Multimorbid patients (OR = 4.43; 3.80-5.17), male (OR = 4.72; 3.83-5.82) and older ones (OR = 1.91; 1.57-2.34) had higher odds of dying. The odds of dying increased with the number of comorbidities from OR=.635; .559-.721 for 1 to OR = 4.23; 3.28-5.46 for 7. From 4967 comorbid diseases (451 ICD-10 codes), only those from code groups A, J, N, E, I, Z were suitable for analysis. Patients with A41.9 (OR = 213.69; 52.88-863.43), J80 (OR = 52.88; 32.58-85.56), N17 (OR = 18.63; 10.24-33.87), E11.7 (OR = 4.72; 3.09-7.19), I13.2 (OR = 4.67; 3.151-6.93), Z95 (OR = 3.81; 2.74-5.31), I63 (OR = 3.56; 2.25-5.61), E66 (OR = 3.12; 2.10-4.64) died more often. Conclusions Our findings match the results based on EMR data: death with COVID-19 was associated with comorbidities (sepsis, acute RDS and kidney, heart and renal failure, diabetes, cerebral infarction, obesity, implants and grafts), age, gender, i.e. HIS administrative data can be used for quick assessment of comorbid patients’ status. Key messages • HIS administrative data can be used for quick assessment of multimorbidity and following personalized treatment is highly recommended to decrease hospital mortality not only in times of pandemic. • Older Bulgarians have many comorbidities from ICD code groups A, J, N, E, I, Z, and are more prone to death, especially in times of pandemic. Public health measures are needed to prevent comorbidity.

Hyperlipidemia interferes with the behavior of variant NKT cells

Abstract Background NKT cells significantly influence atherosclerosis development. However, inconsistent findings on the function of the NKT cells and the invariant subset in atherosclerosis remains a challenge. Moreover, there is no clarity on the role and phenotype of the variant (vNKT) subset in atherosclerosis. Purpose To understand the role of the vNKT subsets in HFD-induced atherosclerosis. Methods We extracted the data for meta-analysis to understand the role of the whole NKT and iNKT cells in atherosclerosis. PRISMA guidelines were followed for the meta-analysis. In addition, C57BL/6 mice (WT) were fed with HFD for 20 weeks from 6-8 weeks of age. vNKTs were identified as CD3+NK1.1+CD1d-tetramer- within the CD3+NK1.1+ NKT cell population in both liver and spleen by flow cytometry. Intracellular cyotkines staining was performed. Statistical differences inthe means of two groups are calculated by two-tailed Student’s t-test with nonparametric Mann-Whitney tests. P-value&amp;lt;0.05 was considered significant. All data represented as mean±SEM. Results The NKT cell numbers increased significantly in the spleen, lymph nodes, blood, and liver in the HFD-fed mice fed from 1.5 to 24 weeks in Apoe-/-, Ldlr-/- in comparison to wild-type mice (SMD, 2.51 [95% CI, 1.42, 3.61]). Contrary to this, the iNKT cell numbers and the iNKT TCR gene expression levels, decreased significantly in the HFD-fed mice (SMD, -2.04 [95% CI, -3.34, -0.75]). The reduction in iNKT cell numbers is also supported by the clinical data from the AMI patients when compared to healthy controls [SMD = -1.81, 95% CI = -2.89, -0.74] (Figure 1). In HFD-fed C57BL/6 hyperlipidemic mice, significantly increased levels of total cholesterol (HFD vs Chow; 226.5±29.66 vs 118.5±10.56 mg/dL, n=4) and LDLc (44.56±11.96 vs 16.69±1.13 mg%, n=4) was observed. The number of vNKTs in the liver was significantly increased by 46% (HFD vs Chow 28.35±2.28 vs 19.41±1.36, n=6-7) (Figure 2A). However, the CD8+ vNKTs were significantly decreased by 68.6% in the liver (4.72±0.99 vs 15.06±0.96) and the CD4+ vNKTs decreased more than two times in the HFD-fed WT liver (7.39±0.76 vs 18.28±0.36) (Figure 2B). Also, the intracellular IFN-γ+ vNKT cells doubled in their numbers in the HFD-fed spleen (14.31±1.39 vs 6.367±0.87) compared to the chow-fed mice (Figure 2C). Conclusion(s) Meta-analysis revealed dual nature of the NKT cells and its invariant subsets in atherosclerosis, since the whole NKTs increase whereas the iNKTs decrease in number. The vNKT subset actively participates in immune modulation in the HFD-induced hyperlipidemia by increasing their number, as well as by differentially regulating CD8 and CD4 co-receptors between chow and HFD. HFD induced a pro-inflammatory nature in the splenic vNKTs but not in liver vNKTs, that in turn may aggravate other immune cells. This data confirms the dual nature of the NKT subsets and reveals a crucial systemic involvement of vNKT cells in the progression of dyslipidemia.

Towers of Kuwait Arabic Neurocognitive Assessment: A novel executive and visuospatial functions assessment tool added to the CERAD neuropsychological battery-Arabic version (CERAD-ArNB)

Assessment of executive and visuospatial neurocognitive domains is lacking in the Omani population, especially for elderly individuals with low educational levels. Therefore, the Towers of Kuwait-Arabic Neurocognitive Assessment (ToK-ArNA) was developed using similar psychometric features of Tower of London (ToL) test, and the unique architecture of Towers of Kuwait, with the potential to overcome the limitation of ToL color perception difficulties that might be encountered in subjects with hereditary or acquired color vision disorders. We enrolled 120 older Arabic-speaking Omanis from January 2022 to November 2022 and all participants underwent screening to ensure normal cognitive function before performing the ToL and ToK-ArNA tests. Validity, reliability, and non-parametric statistical tests were used for data analysis. A total of 85 participants, 51 men (60%) and 34 women (40%) met the inclusion criteria and completed the testing. Statistical analyses confirmed the validity and reliability of ToK-ArNA compared to ToL, with comparable total Time and Accuracy scores and more preference towered the ToK-ArNA among the participants. Despite the study limitations, these results indicate that the ToK-ArNA is a reliable and applicable executive and visuospatial function assessment tool and further studies are warranted to establish its validity in patients with various neurocognitive disorders