Normal Status Research Articles

Global adaptive neural network control of nonlinear time-varying systems with unknown control coefficients and model uncertainties

This paper investigates the adaptive control problem for the strict-feedback nonlinear time-varying system (NTVS) with unknown control coefficients and model uncertainties. To address the problem that the neural network (NN) can only achieve local approximation of unknown nonlinear functions, a novel NN control scheme is proposed. The scheme consists of a NN controller that operates inside the approximation domain and a robust controller that operates outside the approximation domain, and a novel switching function is designed to enable the two controllers to switch smoothly in the vicinity of the approximation domain to ensure that all signals of the closed-loop system are globally uniformly ultimately bounded. To address the problem that unknown time-varying control coefficients are difficult to handle, an adaptive fault-tolerant control scheme is proposed in combination with the congelation of variables method. The scheme employs classical adaptive control to adapt to the variation of unknown control coefficients and robust control to eliminate the time-varying disturbance terms, and introduces a positive integrable time-varying function to achieve asymptotic tracking of an arbitrary reference signal. The combination of these two schemes constitutes a global adaptive neural network control (GANNC) method for the NTVS with unknown control coefficients and model uncertainties. Finally, an adaptive attitude fault-tolerant controller for launch vehicles is designed by using the GANNC method, which can realize the accurate tracking of the attitude control system to the reference command under normal status, strong disturbances and actuator failures, and comparative experiments prove the effectiveness and superiority of the controller.

Return to Work Program for a Chef with Pemphigus Vulgaris : a Case Report

Background: Pemphigus vulgaris is an autoimmune, intraepithelial, blistering disease, affecting the skin and mucosae, is defined by IgG antibody deposits in the keratinocyte membranes of the epidermis, leading to acantholysis with consequent generation of blisters. This disease has recurrence characteristics triggering by various risk factors such as medications, physical agents, infectious agents, hormones, and stress. The aim of this case report is to manage a return to work program for pemphigus vulgaris patient with numerous, widespread, blisters especially on both hands.Case presentation: Fourty-three years old woman presents with a painful and itchy blisters appeared in the palms, feet and body surfaces which are widely spreading throughout this week. The patient reported that the lesions first appeared as an ulcer in the upper lip, followed by cutaneus involvement. On physical examination, vital signs are normal and nutritional status is overweight. Dermatology status found numerous, widespread, tense or flaccide blisters, erosions and pruritic erythema on chest, back, abdomen, both arms and both palms accompanied by black crust with a soliter erosions on the upper lip. She was diagnosed with Pemphigus Vulgaris since 10 December 2020 and was controlled very well since February 2021, when suddenly new blisters started to appear on May 2022.She has got a medical and occupational management for her disease, which let her recovered and ready to go back to work again. Conclusion: Pemphigus Vulgaris could affect patient’s work life. Multiple hazard in the work place also can affect the nature of the disease. Occupational management is important to help patients return to their former work, and to prevent reccurence. As a return to work program, the author recommended several changes in the workplace to reduce the triggering factor, promote self care, did an education, and showed the way to work with a good ergonomic style. Work related stress which act as an exogenous factor triggering Pemphigus Vulgaris need to be controlled. With appropriate medications and interventions to control her occupational risk and exposure, patients can return to work with some modifications.

Spironolactone improves left atrial function and atrioventricular coupling in patients with resistant hypertension.

To determine the blood pressure independent effects of spironolactone on left atrial (LA) size and function in patients with resistant hypertension (RHTN). Patients with RHTN (n = 36, mean age 55 ± 7) were prospectively recruited. Spironolactone was initiated at 25mg/day and increased to 50mg/day after 4 weeks. Other antihypertensives were withdrawn to maintain constant blood pressure. Cardiac magnetic resonance imaging was performed at baseline and after 6 months of spironolactone treatment and changes in LA functional metrics were assessed. LA size and function parameters were improved (p < 0.05) from baseline to month-6: LA volumes indexed to body surface area (LAVI) were reduced (LAVImaximum 41.4±12 vs. 33.2±9.7 mL/m2; LAVIpre-A 32.6±9.8 vs. 25.6±8.1 mL/m2; median LAVIminimum 18.5 [13.9-24.8] vs. 14.1 [10.9-19.2] mL/m2); left atrioventricular coupling index was reduced (28.2±11.5 vs. 22.7±9.2%); LA emptying fractions (LAEF) were increased (median total LAEF 52.4 [48.7-60.3] vs. 55.9 [50.3-61.1] %; active LAEF 40.2±8.6 vs. 43.1±7.8%). LA global longitudinal strain in the active phase was increased (16.3±4.1 vs. 17.8±4.2%). The effect of spironolactone was similar in patients with high (N = 18) and normal (N = 18) aldosterone status (defined by plasma renin activity and 24-h urine aldosterone). Treatment of RHTN with spironolactone is associated with improvements in LA size and function, and atrioventricular coupling, regardless of whether aldosterone levels were normal or high at baseline. This study suggests the need for larger prospective studies examining effects of mineralocorticoid receptor antagonists on atrial function and atrioventricular coupling.

Research on Damage Identification of Arch Bridges Based on Deflection Influence Line Analytical Theory

There is no analytical solution to the deflection influence line of catenary hingeless arches nor an explicit solution to the deflection influence line difference curvature of variable section hingeless arches. Based on the force method equation, a deflection influence line analytical solution at any location before and after structural damage is obtained, and then an explicit solution of the deflection influence line difference curvature of the structural damage is obtained. The indexes suitable for arch structure damage identification are presented. Based on analytical theory and a finite element model, the feasibility of identifying damage at a single location and multiple locations of an arch bridge is verified. This research shows that when a moving load acts on a damaged area of an arch structure, the curvature of the deflection influence line difference will mutate, which proves theoretically that the deflection influence line difference curvature can be used for the damage identification of hingeless arch structures. This research has provided theoretical support for hingeless arch bridge design and evaluation. Combined with existing bridge monitoring methods, the new bridge damage identification method proposed in this paper has the potential to realize normal health status assessments of existing arch bridges in the future.

Total Selenium Level and Its Distribution between Organs in Beef Cattle in Different Selenium Status.

The aim of this study was to determine the Se concentration in the main tissues of beef cattle and to evaluate the differences in tissue distribution between animals with different selenium status. Selenium concentration was determined in the serum, longissimus dorsi muscle, semitendinosus muscle, kidney, heart, liver, spleen and lungs of cows, heifers and beef bulls, using spectrofluorimetric method. Despite receiving supplementation, 55.6% animals demonstrated an optimal Se level, while 44.4% were deficient. The mean serum Se concentration was significantly higher (p < 0.05) in animals with a normal Se status than in Se-deficient animals. Differences in Se tissue distribution were observed between Se-deficient animals and those with normal Se status. The organs most susceptible to Se deficiency are the semitendinosus muscle, lungs, heart and liver. In both normal and Se-deficient animals, significantly higher Se concentrations were observed in the kidney than other organs (p < 0.05), and the lowest in the muscles. As Se deficiencies can be found among supplemented animals, the level of Se should be monitored in beef cattle in order to detect possible Se deficiencies, which may have negative health effects for animals and reduce the value of animal products as a source of Se in the human diet.

Gross motor coordination in relation to weight status: a longitudinal study in children and pre-adolescents.

Gross Motor Coordination (GMC) is crucial for the adequate development of motor competence. Our purpose in this semi-longitudinal study was to evaluate the influence of BMI on GMC in children and pre-adolescents of both sexes, across school years (classes). We evaluated 117 subjects (aged 8-13 years) belonging to three different cohorts for 4 consecutive years, providing data over 6 years (classes). GMC was assessed through the Körperkoordinationstest für Kinder (KTK) test. Class and weight status effects were then evaluated by dividing the subjects into a normal weight group and an overweight group based on their weight status. A significant increase across classes was found for BMI (p < 0.001) and KTK raw score (p < 0.001) and a decrease was found for KTK normalized score (MQ) (p = 0.043). Significantly lower MQ values were found for girls. Absolute GMC increased across the years and there was no difference between boys and girls. Correlations between GMC scores and BMI were negative and significant in 5 of 6 classes. It was confirmed that overweight subjects had lower MQ and RAW values than normal-weight subjects, with no class-by-weight status interaction. The level of competence and its development are strictly dependent on weight status during childhood and pre-adolescence. The present investigation suggests that the adequate development of GMC requires not only targeted physical education programs but also the promotion of healthy habits aimed at maintaining a normal weight status during childhood and pre-adolescence.

Recovery to normal vital functions and acid-base status after a severe trauma in Level I versus Level II Trauma Centres.

In the Netherlands, approximately 70% of severely injured patients (ISS ≥ 16) are transported directly to a Level I trauma center. This study compared the time needed to return to normal vital parameters and normal acid-base status in severely injured patients and some in-hospital processes in Level I versus Level II trauma centers. This retrospective cohort study included all adult severely injured patients or adult trauma patients admitted to the intensive care unit between 2015 and 2020 in a Dutch trauma region. The primary endpoint was time until normal vital parameters and acid-base status. Secondary endpoints were complication rate, hospital length of stay, emergency department length of stay, and time until a computed tomography (CT) scan. A total of 2345 patients were included. Patients admitted to a Level I trauma center had a significantly higher rate of normalization of vital parameters over time (HR 1.51). There was no significant difference in normalization rate of the acid-base status over time (HR 1.10). In Level I trauma centers, time spent at the emergency department and time until the CT scan was significantly shorter (respectively, β - 38min and β - 77min), and the complication rate was significantly lower (OR 0.35). Severely injured patients admitted to a Level I trauma center require less time to normalize their vital functions. Level I centers are better equipped, resulting in better in-hospital processes with shorter time at the emergency department and shorter time until a CT scan.

AGER-1 Long Non-Coding RNA Levels Correlate with the Expression of the Advanced Glycosylation End-Product Receptor, a Regulator of the Inflammatory Response in Visceral Adipose Tissue of Women with Obesity and Type 2 Diabetes Mellitus.

The advanced glycosylation end-product receptor (AGER) is involved in the development of metabolic inflammation and related complications in type 2 diabetes mellitus (T2DM). Tissue expression of the AGER gene (AGER) is regulated by epigenetic mediators, including a long non-coding RNA AGER-1 (lncAGER-1). This study aimed to investigate whether human obesity and T2DM are associated with an altered expression of AGER and lncAGER-1 in adipose tissue and, if so, whether these changes affect the local inflammatory milieu. The expression of genes encoding AGER, selected adipokines, and lncAGER-1 was assessed using real-time PCR in visceral (VAT) and subcutaneous (SAT) adipose tissue. VAT and SAT samples were obtained from 62 obese (BMI > 40 kg/m2; N = 24 diabetic) and 20 normal weight (BMI = 20-24.9 kg/m2) women, while a further 15 SAT samples were obtained from patients who were 18 to 24 months post-bariatric surgery. Tissue concentrations of adipokines were measured at the protein level using an ELISA-based method. Obesity was associated with increased AGER mRNA levels in SAT compared to normal weight status (p = 0.04) and surgical weight loss led to their significant decrease compared to pre-surgery levels (p = 0.01). Stratification by diabetic status revealed that AGER mRNA levels in VAT were higher in diabetic compared to non-diabetic women (p = 0.018). Elevated AGER mRNA levels in VAT of obese diabetic patients correlated with lncAGER-1 (p = 0.04, rs = 0.487) and with interleukin 1β (p = 0.008, rs = 0.525) and resistin (p = 0.004, rs = 0.6) mRNA concentrations. In conclusion, obesity in women is associated with increased expression of AGER in SAT, while T2DM is associated with increased AGER mRNA levels and pro-inflammatory adipokines in VAT.

Соотношение возбудительных и тормозных синаптических процессов в антиноцицептивных ядрах PAG и RMG в их реципрокных взаимоотношениях в интактном препарате с воздействием гидрокортизона

Microelectrophysiological studies were carried out on 12 intact Albino rats (250±30 g) with hydrocortisone injection, compared with the norm. A software mathematical analysis of a single spike activity of 282 neurons was carried out. The spike activity of single PAG and RMG neurons was recorded extracellularly in separate series of experiments, with successive involvement of each of them as stimulated and recorded. When assessing the relative degree severity of depressor and excitatory post-stimulus effects, using the example of diagrams of the average spike frequency in PAG at HFS RMG under hydrocortisone exposure in normal conditions, both in the depressor and excitatory sequences, in comparison with those without hydrocortisone, no significant changes were detected, but there was a greater severity of these values in the norm without hydrocortisone, in particular, preceding excitatory effects, which indicates not only the harmlessness of the indicated dose of hydrocortisone, but also a certain improvement in the normal status. In RMG neurons on HFS PAG, both in the norm without and under hydrocortisone exposure, a protective increase in tetanic depression was revealed in both sequences, without excess of poststimulus excitability. In general, for both PAG and RMG, a greater severity of pre- and post-stimulus frequency, preceding and accompanying excitatory effects in the norm without hydrocortisone, and a greater balance of depressor and excitatory post-stimulus manifestations of activity under hydrocortisone exposure than in the norm were revealed, which indicates the safety and even the benefit of that dose of hydrocortisone.

A statistical study of postmortem heart weight in Chinese adults

IntroductionObjective assessment of cardiac hypertrophy in forensic pathology practice is of great significance for forensic pathologists, for whom reference values for normal heart weights are needed. Developed regions such as Europe, the United States, and Japan recalculate the weight of human organs at regular intervals, but in China, there has been no systematic calculation of the weights of human organs since 2006. AimsTo statistically analyse the heart weight of Chinese adults postmortem and obtain a reference range. Materials and Methods4170 adult autopsy reports were collected from 12 forensic departments in 10 provinces in China. The causes of death were classified by sex, and heart weight and the heart weight/body height ratio reference values were further calculated according to different body mass index and body heights. Finally, the cutoff value of cardiac hypertrophy in Chinese adults was calculated. ResultsIn the group of non-cardiovascular disease causes of death, the cardiac weight of the electric death group was higher, while the heart weight of the prolonged bed-rest group was significantly reduced. After the electric death and prolonged bed-rest groups were excluded, heart weight, the heart weight/body height ratio, and cutoff values for cardiac hypertrophy were further classified and analysed according to body mass index. The mean reference values for heart weight in men and women with normal weight status were 325.82 ± 41.60 g and 286.39 ± 44.84 g, and the heart weight/body height ratios were 1.95 ± 0.23 in men and 1.82 ± 0.27, respectively. The cutoff values for cardiac hypertrophy were 387.35 g for men and 346.80 g for women. ConclusionThe heart weight reference values of both sexes in this study were significantly higher than those in 2006, which is considered related to the development of China's economy and the improvement of people's living standards. This study also suggests the need for a new round of statistical surveys and updated data on the weight of other organs.

MANILA BAY WATERSHED SCORECARD: A GIS-BASED QUANTITATIVE WATERSHED HEALTH ASSESSMENT

Abstract. Watershed health refers to the maintenance of the normal status of a watershed. With the use of Geographic Information Systems (GIS), a watershed health assessment framework was developed and applied to the Manila Bay Watershed (MBW) based on the sub-indices used by the US EPA and the Minnesota DNR. These three sub-indices were used and modified: geomorphology, connectivity, and hydrology. Geomorphology sub-index accounted for the effects of soil erosion using the Unit Stream Power-based Erosion/Deposition model (USPED). Connectivity sub-index considered the connection between habitats within three environments: terrestrial, aquatic, and riparian zone. Hydrology sub-index accounted for the effects of impervious cover and urbanization on the movement of water using three factors, namely, natural cover, tree cover, and loss of hydrologic storage. Land cover map was the most used dataset in this scorecard, where the maintained natural land covers generally received high scores and built-up areas received the lowest. The overall watershed health score of MBW is 75.713 from the mean of the three sub-indices. Pampanga River Basin, which is the largest river basin within the MBW, got the highest score of 79.462 since it consists of huge portions of maintained natural land cover. Manila River Basin, known to have dense built-up areas, got the lowest average of 60.773. On the provincial level, the province of Nueva Ecija got the highest score, and the National Capital Region (NCR) got the lowest. The developed framework successfully quantified a relative health score which can be used to rank and prioritize subwatersheds, and to measure in totality the improvement or degradation of subwatershed/s over time.

Vitamin D supplementation in children with urinary tract infection

Urinary tract infections (UTIs) are one of the most common bacterial infections in the global population. Vitamin D deficiency is also an urgent and common problem, and the high incidence of hypovitaminosis does not depend on age, sex, nationality, and geographical location. Along with the so-called "classical" effects of cholecalciferol, no less significant non-calcemic functions of cholecalciferol have been actively studied over the past two decades, particularly its effect on inflammation and its role in anti-infectious immunity. More and more data on the relationship between UTIs and vitamin D deficiency supports the possible use of cholecalciferol as an adjuvant to basic UTI therapy.&#x0D; Aim. To analyze the vitamin D status in children with UTI compared to healthy ones.&#x0D; Materials and methods. The study included 75 children from 1 month to 18 years with UTIs of various localization treated in a healthcare institution in Stavropol. The mean age of the study patients was 6.0±0.3 years. Vitamin D status was based on serum calcidiol [25(OH)D3] level.&#x0D; Results. The vitamin D level is statistically significantly higher in children of the control group than in patients with UTI: 36.42 ng/mL [24.92–46.37] vs 24.13 ng/mL [13.75–36.42], respectively (p=0.003). There were no patients with severe vitamin deficiency in the control group, while in the UTI group, it occurred in 20.0% of patients. The vitamin D level was less than 20 ng/mL in 31 (41.3%) children with UTI and only 2 (6.6%) in the control group (p=0.001). Normal vitamin status was found in only 38.7% of patients with UTI compared to 66.7% of healthy children (p0.01). The lowest level was found in patients with acute cystitis – 19.7 ng/mL [9.8–19.7], and the highest in patients with acute pyelonephritis – 31.9 ng/mL [14.3–36.4].&#x0D; Conclusion. Based on the study results, it can be concluded that vitamin D deficiency may be one of the risk factors for developing UTIs in children. Further studies involving more patients are needed.

RESTING‐STATE ELECTROENCEPHALOGRAPHIC RHYTHMS UNDERPINNING VIGILANCE ARE ABNORMAL IN POST COVID‐19 PATIENTS EXPERIENCING FATIGUE

AbstractBackgroundPrevious evidence showed that persons experiencing post‐COVID‐19 with “brain fog” were characterized by abnormal resting‐state electroencephalographic (rsEEG) rhythms reflecting vigilance dysfunctions. In the present exploratory study, we tested the hypothesis that in post‐COVID persons with normal cognitive status, abnormalities in those rhythms (and vigilance function) may be related to fatigue.MethodWe enrolled post‐COVID participants about one year after their infection, which claimed “brain fog.” They underwent clinical/neuropsychological assessment and 61‐channel‐EEG recordings. Matched controls (never COVID‐19 affected) were included. Using eLORETA freeware, regional neural current densities were estimated in the rsEEG cortical sources at individual delta, theta, and alpha bands and at beta and gamma fixed bands. Clinical and instrumental data were evaluated in the long COVID‐19 patients as a function of fatigue symptoms over the controls.ResultThe post‐COVID patients had no cognitive deficits at the group level. Those patients showed lower posterior rsEEG alpha source activities than the controls. Notably, this effect was more significant with the long COVID‐19 patients experiencing fatigue symptoms than those without (Fig. 1).ConclusionIn post‐COVID patients with normal cognition, abnormal rsEEG alpha source activation may indicate a significant relationship between vigilance dysfunction and fatigue.

Developing Topics.

Phosphorylated tau (pTau) in cerebrospinal fluid (CSF) is a biomarker of Alzheimer's disease (AD) pathology. Recent studies confirm that pTau levels in plasma may provide a more cost-effective and less invasive method of assessing AD pathology, which have shown to also be relevant in preclinical populations. Neurofilament light (NfL) is a measure of neuroaxonal damage associated with poorer cognitive outcomes. Generalization is a validated cognitive marker of hippocampal dysfunction, with individuals showing deficits years before overt cognitive impairment. Using a computer generalization task sensitive to medial temporal lobe (MTL) pathology, the current study examined the relationship between generalization performance and plasma pTau and NfL levels in a population with elevated AD risk, older African Americans. 130 older, cognitively normal African Americans (M age = 71.60 years, SD = 6.58; M edu = 13.88 years, SD = 2.37; n = 98 women) provided blood samples and completed a hippocampal-dependent cognitive task. Participants' normal cognitive status was confirmed using the Mini-Mental State Examination (M MMSE = 26.98, SD = 2.14) and generalization performance was assessed using the Acquired Equivalence Task. Plasma was extracted from blood samples to assess pTau181, pTau231, and NfL levels. Based on the sample median thresholds, participants were characterized as plasma tau positive (≥16.189 for pTau181 and ≥17.537 for pTau231). Participants positive for plasma pTau231 (n = 76) demonstrated worse generalization performance with increased pTau231 levels, B = -0.296, p = 0.024, as did participants positive for plasma pTau181, B = -0.247. p = 0.042, demonstrating that tau positivity status is related to MTL dysfunction. Moreover, pTau231 was more strongly associated with generalization performance, indicating that it is a more sensitive biomarker than pTau181 among preclinical AD populations. Higher levels of plasma NfL were also significantly associated with lower generalization performance B = -0.243. p = 0.008. Plasma isoforms pTau181 and pTau231 may reflect different phases of tau progression, with plasma pTau231 shown to be better at capturing subtle MTL dysfunction. Plasma tau positivity status and measures of axonal damage along with lower generalization performance scores may be useful indicators of cognitive dysfunction in preclinical AD populations.

Relationship between Physical Activity, Handgrip Strength, Depressive Symptoms, and Cognitive Impairment in Korean older adults

AbstractBackgroundPhysical activity, muscle strength, depressive symptoms, and cognitive function are intertwined in later life. This study aimed to investigate the association physical activity (PA), relative handgrip strength (RHGS), depressive symptoms, and cognitive impairment in Korean older adults.MethodThis study consisting of 512 community‐dwelling Korean older adults (417 female, 95 male) aged 65 years and older (74.8±5.4 years) in S‐city, Gyeonggi‐do. PA and handgrip strength were assessed with the Global Physical Activity Questionnaire and using a dynamometer (GRIP‐D; Takei Ltd, Niigata, Japan). Depressive symptoms were evaluated using the Korean form of the Center for Epidemiologic Studies Depression (CES‐D) Scale. Cognitive impairment was assessed with the Mini‐Mental State Examination for Dementia Screening (MMSE‐DS) of Korean version. The PROCESS V3.4 macro for SPSS based on the bootstrap method was used to determine the mediating effects of PA and RHGS on the relationship between depressive symptoms and cognitive impairment.ResultMultiple logistic regression showed that insufficient PA was associated with high odds of a cognitive impairment ((OR = 2.972, 95%CI = 1.749‐5.052, p = .002) compared with sufficient PA (OR = 1). Weak RHGS (OR = 3.540, 95%CI = 2.156‐5.814, p&lt;.001) was associated with high odds of the cognitive impairment compared with normal RHGS (OR = 1). Depressive symptoms (OR = 2.676, 95%CI = 1.594‐4.492, p&lt;.001) were associated with higher odds of the cognitive impairment compared with normal depression status (OR = 1). Particularly, depressive symptoms were found to have both direct and indirect effects on cognitive impairment. As predicted, PA and RHGS partially mediated the relationship between depressive symptoms and cognitive impairment (PA: B = –0.017, 95%CI = –0.028 ‐ –0.009, p&lt;.001; RHGS: B = –0.005, 95%CI = –0.007 ‐ –0.003, p&lt;.001). In addition, serial mediation analysis indicates that the association between depressive symptoms and cognitive impairment was partially mediated by PA and RHGS in a sequential manner (B = –0.004, 95%CI = –0.006 ‐ –0.002, p&lt;.001).ConclusionAccording to the results of the serial multiple mediation model, the elderly should be encouraged to continue their physical activity in daily life, which not only improves and maintaining muscular strength but also reduces the negative impact of depressive symptoms on cognitive impairment.

High late‐life physical activities and reduced progression from MCI to Alzheimer’s dementia

AbstractBackgroundPhysical activity (PA) has been reported to reduce the risk of Alzheimer`s disease (AD) dementia and related cognitive decline. We aimed to investigate the influence of PA on the progression from cognitively normal (CN) status to mild cognitive impairment (MCI) or from MCI to AD dementia in non‐demented older adults.MethodThis study included 194 non‐demented (148 CN and 46 MCI) participants from the Korean Brain Aging Study for Early diagnosis and prediction of Alzheimer’s disease (KBASE), who completed both baseline and 2‐year follow‐up clinical evaluation. At baseline, the participants underwent comprehensive clinical and neuropsychological assessment, multimodal brain imaging including [11C] Pittsburgh Compound B positron emission tomography (PET), [18F] fluorodeoxyglucose PET and MRI, and current PA measured using the Lifetime Total Physical Activity Questionnaire.ResultAfter 2 years, five CN and 22 MCI participants progressed to MCI and AD dementia, respectively. Logistic regression analyses showed that high current PA (above the median value) reduced the risk of the progression from MCI to AD dementia even after controlling age, sex, education, apolipoprotein E e4 positivity, baseline brain amyloid deposition, AD‐signature region glucose metabolism, and AD‐signature region cortical thickness (Bonferroni corrected p‐value = 0.028). In contrast, PA had no effect on the progression from CN to MCI.ConclusionThe findings suggest that a physically active lifestyle in late‐life reduces the risk of conversion to AD dementia in MCI independently of AD‐related brain pathologies.

The relationship between obstructive sleep apnea and haemoglobin A1c and the moderating role of glycaemic status in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

This study investigated the relationship between obstructive sleep apnea and haemoglobin A1c (HbA1c) among Hispanics/Latinos in the United States and assessed whether this relationship was moderated by glycaemic status. This was a cross-sectional analysis of the Hispanic Community Health Study/Study of Latinos cohort. The sample consisted of 13,394 participants with valid measures of obstructive sleep apnea, HbA1c, and study covariates. Obstructive sleep apnea was assessed with the apnea-hypopnea index and categorised as obstructive sleep apnea if the apnea-hypopnea index was ≥5 events/h. HbA1c measures were obtained through fasting blood samples. Fasting plasma glucose (FPG), 2-h post-load plasma glucose (2h-PG) and use of antihyperglycaemic medications were used to define glycaemic status (i.e., normoglycaemia [FPG < 5.6 mmol/L (< 100 mg/dL) and 2h-PG < 7.8 mmol/L (140 mg/dL)], prediabetes [FPG 5.6-6.9 mmol/L (100-125 mg/dL), and/or 2h-PG 7.8-11.0 mmol/L (140-199 mg/dL)], diabetes without treatment [FPG > 7.0 mmol/L (≥ 126 mg/dL) and/or 2h-PG ≥ 11.1 mmol/L (≥ 200 mg/dL)], and diabetes with treatment. Multivariable linear regression was used to calculate adjusted least square means. Overall, 25.9% of the sample had obstructive sleep apnea and 49.2% had normal glycaemic levels, 36.1% had prediabetes, 6.5% diabetes without receiving treatment, and 8.3% diabetes and undergoing treatment for it. Participants with obstructive sleep apnea had significantly higher adjusted mean HbA1c (adjusted mean [standard error] 5.85 [0.03)]) than those without (5.70 [0.02)]; p < 0.001). Models stratified by diabetes status showed that the association between obstructive sleep apnea (versus not) and higher HbA1c was only for participants with normal glycaemic status (adjusted mean [standard error] 5.27 [0.01] versus 5.30 [0.01]; p = 0.013) and prediabetes (5.59 [0.01] versus 5.66 [0.01]; p < 0.001). In conclusion, obstructive sleep apnea was associated with higher HbA1c in a diverse sample of Hispanic/Latino adults in the United States. This association was present only for participants with normal glycaemic status or with prediabetes. Studies are needed to further understand the clinical implications of the association between obstructive sleep apnea and HbA1c according to glycaemic status.

Normative Data of Beta-2-Microglobulin and Plasma Proteins from an Agrarian Indian Community By a Door-to-Door Survey: Results of Simple (IMAGe-002B) Study

Introduction: Most diagnostic laboratories in India follow the reference intervals given in Western literature whose Caucasian reference population is entirely different from the Indian ethnic population (viz., dietary habits, lifestyle, socioeconomic status, ethnicity, and environmental factors). Objectives: To collate normative data of beta-2-microglobulin (β2M) and plasma proteins from an otherwise healthy population from an agrarian Indian Community. The secondary objectives were to evaluate the correlation of β2M levels with age, gender, and BMI of these individuals. Methods: A cross-sectional study was conducted in an agrarian village in India with a 24.76Km perimeter and 4588.3 hectares with an 89.2% population coverage for adults (&amp;gt;45y) spending 12096 man-hours. This was a part of SIMPLe (Screening Intervention for Myeloma and Prevention of Lifestyle diseases) study registered vide CTRI/2023/03/051220 after obtaining informed consent. Demographic details, medical history, and blood samples were collected after a thorough medical examination to ascertain the normal health status of the study participants. Hemogram, biochemistry (Liver and renal function tests), β2M, and serum protein electrophoresis (SPEP) were performed in all individuals. Only individuals with normal renal and liver function tests were included in the final analysis. Bivariate analysis (Fit Y by X) was done to study the correlations. Any p value &amp;lt; 0.05 was considered significant. The data was analyzed using JMP ver. 16.0.0. Results: A total of 850 individuals were included in this community-based door-to-door survey. The mean age of the study population was 57.6±10.5y, with a slight female predominance (56.3%). The distribution of β2M and various plasma proteins is mentioned in Table 1. The β2M significantly differed between males and females (χ 2-8.58; dF-1; p-0.0034). On bivariate analysis, β2M was significantly associated with age (correlation coefficient: 0.31; p&amp;lt;0.0001), and BMI (correlation coefficient -0.07; p-0.023). Conclusion: The data obtained from our studies would act as the first step in collating normative data for β2M and plasma proteins from Indian community.

Re-thinking the value of cross-sectional torso imaging for ground-level fall patients with altered mental status: Outcomes from a level 1 trauma center

IntroductionPatients with altered mental status (AMS) are often excluded from studies evaluating the utility of computed tomography of the torso (CTT) after ground level falls (GLF). It is not known whether CTT identifies otherwise undetectable injuries in patients with AMS after GLF. We sought to describe the value of performing CTT in patients with AMS after GLF, and hypothesized that CTT would not identify new, clinically significant injuries in patients with a normal torso physical exam (PE) and normal chest and pelvic radiographs (CXR/PXR). MethodsSingle-institution retrospective cohort study of GLF patients (≤1 m) with and without AMS (GCS <15, blood alcohol level >150 mg/dL, intubation prior to hospital evaluation), 2015–2019. Traumatic injury identification on CTT was evaluated in the context of normal/abnormal torso PE (based on provider documentation) and normal CXR/PXR. Results1195 patients met inclusion criteria; 344 had AMS, of which 129 (37.5 %) underwent CTT. A further 851 patients had normal mental status, of which 180 (21.2 %) underwent CTT. Patients with a normal PE with AMS (N = 79) and without AMS (N = 38) had a similar rate of new injury discovery on CTT (6.3% vs. 7.9 %, p = 1.00). Negative PE had a negative predictive value (NPV) for identification of a new, acute traumatic injury of 92.4 % (95 % CI: 0.84–0.96) in patients with AMS while normal PE, CXR, and PXR had a NPV of 96.0 % (95 % CI: 0.80–0.99). Among patients with CTT, patients with AMS had a significantly lower rate of acute traumatic injury on CTT compared to alert patients (26.4 % vs. 48.9 %, p < 0.001). On multivariate analysis, AMS was not positively associated with likelihood of identifying acute traumatic injury on CTT. ConclusionsIn patients sustaining GLFs who present with AMS and who otherwise have a negative PE, CXR, and PXR, CTT is very unlikely to identify new traumatic injuries. Strong consideration should be given to forego cross-sectional imaging in this patient population.

Role of copper and its complexes in cardiovascular diseases.

Copper is a trace element essential for the maintenance of normal physiological functions in cardiovascular system, and its transport and metabolisms are regulated by various copper proteins such as copper-based enzymes, copper chaperones and copper transporters. The disturbance of copper level or abnormal expression of copper proteins are closely associated with the development of cardiovascular diseases such as atherosclerosis, hypertension, ischemic heart disease, myocardial hypertrophy and heart failure. Thus, intervention of copper ion signaling pathways is expected to be an effective measure for treating cardiovascular diseases. Some copper complexes, such as trientine, copper-aspirinate complex and copper (II) diethyldithiocarbamate, have been found to play a role in the prevention and treatment of cardiovascular diseases and possess potential prospects. Exploring the role of copper in maintaining normal cardiovascular status and the potential application of copper complexes in the treatment of cardiovascular diseases may lay a foundation for finding new targets for prevention and treatment of various cardiovascular diseases, and provide new ideas for clinical treatment of cardiovascular diseases.