Saint Louis University Research Articles

Development and validation of a natural language processing system that extracts cognitive test results from clinical notes

AbstractBackgroundCognitive test results from electronic health records (EHRs) are key information for assessing the severity and progression of patients with mild cognitive impairment (MCI) and Alzheimer’s’ disease (AD). However, such information is often recorded in unstructured clinical notes rather than in an administrative database. We developed and validated a natural language processing (NLP) system to extract cognitive test results from clinical notes in the Veterans Affair (VA) Healthcare System.MethodAn NLP system was developed using regular expression‐based rules and Python to extract results for six tests that have been used most frequently in VA: Mini‐Mental State Exam (MMSE), Montreal Cognitive Assessment (MoCA), Saint Louis University Mental Status Examination (SLUMS), Mini‐cog, Boston Naming Test (BNT), and Benton Visual Retention Test (BVRT). The system extracted test results from each note in two steps: (1) searched a test name, or variations and abbreviation of the test name and, if successful, (2) searched the quantitative results (e.g., 12/30 for MMSE, 74th percentile for BNT) and/or descriptive results (e.g., “borderline impairment” for BVRT) within 5 words or one sentence before or after the test name. To balance the system performance and speed, we developed 3‐8 extraction rules per test based on a manual review of 30‐50 notes for each test. We further validated NLP performance on 6 held‐out datasets (50‐200 notes/test). We automatically sampled the development and held‐out notes by searching the test name and its variations/abbreviation to increase positive cases, i.e., notes that contained the above test results.ResultThe NLP system achieved 0.72‐0.92 predictive positive values (PPV), 0.96‐1.00 recall, and 0.83‐0.95 F1 scores on the validation test sets (Table 1). In addition, it demonstrated a scalable performance (processed 200,000 notes in 7 min), allowing an extraction of millions of notes from ∼1 million patients within hours.ConclusionRule‐based NLP can extract cognitive test results with adequate performance and scalable capability for clinical notes from patients with MCI or AD within the VA Healthcare System.

Engagement in Meaningful Activities Among Residents with Dementia in Assisted Living

AbstractBackgroundEngagement in meaningful activities is beneficial for the physical and psychological well‐being of persons with Alzheimer’s disease or related dementia (ADRD). Meaningful activities are a critical dimension of person‐centered care, although challenges exist in providing them for persons with ADRD in long‐term care settings. The purpose of this study was to describe engagement in meaningful activities among residents with ADRD in assisted living.MethodThis study included baseline data collected from the first cohort of the randomized controlled trial, Meaningful Activities for Managing Behavioral Symptoms of Distress (MAC‐4‐BSD). Assisted living residents were eligible if they were ≥55 years old, live in a participating setting, and screen positive for dementia based on the Saint Louis University Mental Status exam (SLUMS) and AD8 Dementia Screening Interview. Residents were excluded if they were enrolled in hospice, admitted for short term respite, or had a significant neurological condition not related to ADRD. Residents’ engagement in meaningful activities was evaluated based on the Engagement in Meaningful Activities Survey (EMAS). Descriptive statistics were used to summarize sample characteristics and describe engagement in meaningful activities.ResultA total of 38 residents from 3 assisted living communities were included in the sample. Most participants were female (71%), White (82%), and mean age was 81 years old (SD = 7.9). Average score on the SLUMS was 4.5 (SD = 4.9). The EMAS mean score was 43.57 (SD = 10.9) with a range of 25 to 60. Participation was endorsed most frequently for activities that give them pleasure (60.7%) and a sense of satisfaction (64.3%). Participation was endorsed least frequently for activities that help other people (35.7%), contribute to feeling competent (42.9%), and have the right amount of challenge (42.8%).ConclusionFindings from this study offer preliminary insights into residents’ engagement in meaningful activities in assisted living and suggest there is limited participation in activities that help others, help with feeling competent, and have the right challenge level for those with ADRD. Although limited by small sample size, this study highlights the need for increasing engagement in meaningful volunteer activities to help others which recent research demonstrates could positively impact physical and cognitive health outcomes.

Clinical Manifestations.

Digital cognitive assessment solutions can overcome some barriers to cognitive screening in primary care by providing rapidly-obtained objective insights without requiring specialty-trained examiners. The Linus Health Digital Clock and Recall (DCR™) is a three-part test consisting of three-word immediate verbal acquisition, the Digital Clock Test (DCTclock™), and delayed recall of the three words. Our objective was to compare performance on the DCR to the Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) and the Saint Louis University Mental Status (SLUMS; Tariq et al., 2006), two commonly used screening tests in primary care. Comparative analyses of DCR, MoCA (Total Score and Memory Index Score [MIS]), and SLUMS results were conducted among 80 primary care patients - 65 years and older presenting for any reason - whose DCR performance was indicative of cognitive impairment. Of the 80 patients (mean age 74.0 [±7.8]; 60% female) performing as impaired or borderline impaired on the DCR, 67 completed the MoCA and 13 completed the SLUMS. Comparison between the DCR and MoCA Total Score included 78% (52/67) concordance for identifying impairment (cutoff <26). While the remaining 15 of 67 patients (22%) had normal MoCA Total Scores (≥26), 13 (87%) missed points in at least one MoCA cognitive domain and 8 (53%) missed points in multiple MoCA domains (often language and delayed recall). Comparison between DCR and SLUMS revealed that all 13 patients receiving SLUMS assessment had DCR scores 0-1 and SLUMS scores <27 (indicating cognitive impairment). See Tables 1 and 2 for breakdown of MoCA, MIS, and SLUMS stratified by DCR performance. Logistic regression found that DCTclock metrics of information processing (z = 2.00, p = .045) and spatial reasoning (z = 2.82 p = .005) discriminated cognitive impairment on MoCA Total Score (cutoff <26). Overall, ROC analysis revealed good accuracy of DCR to identify MoCA performance (AUC = .84; Figure 1). Screening in primary care using the DCR is feasible, takes less time to administer than MoCA or SLUMS, and shows concordant results with these more established screening tools in detecting cognitive impairment. Future research aims to investigate the criterion validity of the DCR among biomarkers for neurodegenerative disease.

The Effect of a Merit Point Incentive System on the Willingness to Donate Organs

Although over 90% of the population of the United States supports organ donation, only 60% of the population is registered as donors. Currently, there is a need for a nonmonetary incentive that will improve willingness to donate. We assessed the young adult population's perspective on their willingness to donate organs when merit points are granted to their family members to prioritize their potential transplant if needed. We administered a Qualtrics survey from March 2022 to September 2022 to the undergraduate students volunteering to participate at Saint Louis University, which comprised 10 questions that addressed the attitudes of participants regarding the effects of various factors, including the type of donation and the presence of merit points (vouchers granted to self or a family member to facilitate a potential transplant if needed), on participant's willingness to donate an organ while alive or after death. The responses were analyzed by using SAS software (SAS Institute). A total of 572 participants completed the survey. Overall, only 6.5% of surveyed students were unwilling to donate after death. The willingness to donate while alive to a family member was significantly higher than donating to a stranger (95.8% vs 71.2%, P < .0001). When merit points were added, the unwillingness to donate significantly decreased from 6.5% to 3.8%. However, this change was observed only when the merit points were given to a family member and not to self. When merit points were granted, unwillingness to provide a living donation to a stranger decreased from 28.8% to 16.4% (P < .0001). Merit points to first-degree family members improve students' expressed willingness to donate organs after death; however, self-merit points did not decrease the rate of "unwillingness to donate after death." When living donation is assessed, offering merit points appears to decrease the "unwillingness to donate to strangers." The adoption of a merit point system in the United States may increase the rates of organ donation.

Enhancing apathy treatment in Jordanian people living with dementia residing in care homes using virtual reality reminiscence therapy

PurposeThis paper aims to explore examine the therapeutic potential of head-mounted display (HMD)-based Virtual Reality Relaxation Therapy (VRRT) sessions for people individuals with dementia in Jordan.Design/methodology/approachThis cross-sectional survey recruited 75 dementia-diagnosed elderly individuals from three Jordanian care homes. A VRRT intervention comprising 10 tailored RT sessions held over the course of five weeks was administered to the participants. Apathy, cognitive performance, anxiety and depression were evaluated before and after the intervention to determine any changes. The Person-Environment Apathy Rating Scale's (PEARS) Arabic translation's validity and reliability were also evaluated.FindingsThe VRRT intervention yielded noteworthy results in reducing apathy, as indicated by a substantial decrease in PEARS scores from 17.20 to 11.15. The findings of the study revealed that the participants demonstrated enhanced cognitive abilities, as evidenced by a significant rise in their Saint Louis University Mental Status ratings, which increased from 15.11 to 19.70. The levels of anxiety and depression exhibited a significant decrease subsequent to the implementation of VRRT, with anxiety levels decreasing from 13.66 to 8.23 and depression levels decreasing from 13.62 to 9.33. Furthermore, a notable 70% of participants demonstrated statistically significant decreases in indifference.Practical implicationsThis study makes a significant contribution to the advancement of innovative treatment approaches aimed at addressing the needs of the aging population, hence enhancing health outcomes and raising the quality of care in Jordan.Originality/valueThe effectiveness of VRRT in reducing apathy among Jordanian senior citizens residing in nursing homes has not yet been fully investigated. Therefore, this paper seeks to assess the effectiveness of HMD-based VRRT by conducting pre- and post-intervention evaluations. This research aims to provide valuable insights into the applicability and significance of VRRT in the Jordanian context, contributing to the development of culturally appropriate and cutting-edge therapeutic interventions for older individuals in Jordan. Through this study, the authors aim to promote improved health and elevated standards of care for this population.

FRI433 Hypogonadism In Males With Adrenoleukodystrophy

Abstract Disclosure: J. Ramirez Alcantara: None. N. Grant: None. T.L. Stanley: Research Investigator; Self; Pfizer, Inc. F. Eichler: Consulting Fee; Self; consultant to Alnylam, Autobahn, Ionis, Minoryx, Orchard, Origen, Poxel, Takeda Therapeutics,and Taysha Gene Therapies, is a consultant to Third Rock Ventures on rare neurological disorders. Grant Recipient; Self; GLIA-CTN from National Institute of Neurological Disorders and Stroke (NINDS). Owner/Co-Owner; Self; founder of SwanBio Therapeutics. Research Investigator; Self; primary investigator (PI) of ex vivo lentiviral gene therapy trial in cerebral adrenoleukodystrophy sponsored by bluebird bio, the site-PI of Minoryx trial of leriglitazone for adrenomyeloneuropathy. N.A. Tritos: None. X-linked adrenoleukodystrophy (ALD) is a rare peroxisomal disorder caused by mutations in the ABCD1 gene. Little is known about the prevalence and characteristics of hypogonadism in ALD.We conducted a retrospective chart review to investigate hypogonadism in adult males with ALD. The presence of hypogonadism was determined by a clinician’s diagnosis and/or a total testosterone (TT) level below 249 ng/dL. Prospectively, we distributed a survey and evaluated serum gonadotropins and TT levels. The survey included the quantitative Saint Louis University Androgen Deficiency in the Aging Male (qADAM) questionnaire, a standardized screening tool for hypogonadism (score range: 10-50, lower scores indicate more symptoms). The normal laboratory ranges were 249-836 ng/dL (TT), 1-12 IU/L (FSH), and 2-12 IU/L (LH).We included 56 patients in the study (median age 36.2 years, range 19.3-72.4 years). Forty-seven (84%) patients had signs of myelopathy and 46 (82%) had adrenal insufficiency. Puberty data were available for 11 (20%) patients; two had documentation of delayed puberty onset, one of whom required testosterone treatment at age 15 years to jumpstart puberty. Thirty-one (55%) patients had erectile dysfunction and 24 (43%) used phosphodiesterase-5 inhibitors. Three patients had low libido and two had anorgasmia. Fifteen (27%) patients, two of whom required fertility treatment, had children. Nine (16%) patients had hypogonadism (median [IQR] age of diagnosis 37.4 [35.7,39.0] years), six of whom were on testosterone replacement. The median [IQR] TT level was 200 [143,240] ng/dL at the time of hypogonadism diagnosis. In patients with normal TT, the median [IQR] TT level was 498 [445,615] ng/dL. Twenty-two patients had LH levels and 18 had FSH levels available from clinical testing. In patients with hypogonadism, the median [IQR] levels for LH and FSH were 8.2 [7.2,8.4] and 8.3 [7.4,8.3] IU/L respectively. In patients with normal TT, the levels were 7.6 [5.7,10.4] and 4.0 [3.0,5.3] IU/L. There were no differences in LH or FSH levels between patients with normal TT and hypogonadism. Eight patients completed the prospective survey (median age 38.1 years). The median age of reported puberty onset was 13 years (range 12-15). Four patients, one of whom required fertility treatment, had children. Two (25%) patients reported low libido and 3 (38%) reported ED. The mean qADAM score was 36.5 (SD 5). We obtained prospective laboratory evaluation in ten patients. Median [IQR] levels were 564 [504,663] ng/dL (TT), 6.9 [5.4,9.8] IU/L (FSH), and 11 [7.2,13.8] IU/L (LH). In contrast to the retrospective clinical cohort, no patients had laboratory evidence of hypogonadism. Our results suggest that males with ALD may be at higher risk of developing central hypogonadism. In addition, ED and low libido may be present in males with ALD without laboratory evidence of hypogonadism. Presentation: Friday, June 16, 2023

Performance of illiterate and low-educated Egyptian elderly in SLUMS (Saint Louis University Mental Status) Examination.

Performance of illiterate and low-educated Egyptian elderly in SLUMS (Saint Louis University Mental Status) Examination.

Clinical Characteristics of Gram-Negative Surgical Site Infections in Patients Treated With Mohs Micrographic Surgery: A Retrospective Analysis.

Surgical site infections (SSIs) are the most common adverse events after Mohs micrographic surgery (MMS). However, there is a paucity of literature characterizing gram-negative (GN) SSIs after MMS. This study aimed to depict the clinical features and risk factors of GN infections after MMS. A retrospective review was performed from all postoperative wound cultures after MMS from 2017 to 2021 at Saint Louis University Medical Center. Patient demographics, surgical details, and wound clinical characteristics at follow-up appointments were reviewed. Six hundred and seventy-six wound cultures were eligible with 15.1% yielding GN infection. Gram-negative SSIs had significantly lower rates of severe erythema and purulence compared with gram-positive (GP) SSIs, and only had significantly more edema compared with culture-negative wounds ( p < .05). Although not significant, there was a trend for GN SSIs to have higher rates of pain compared with culture-negative wounds ( p = .075). Gram-negative SSIs after MMS may present with more subtle clinical features, especially compared with typical GP infections. Having a low threshold for obtaining wound culture for edematous or painful postoperative wounds may aid in detecting potentially overlooked GN infections.

44301 Patient Satisfaction and Outcomes within a Free Dermatology Clinic Implemented at Saint Louis University School of Medicine

44301 Patient Satisfaction and Outcomes within a Free Dermatology Clinic Implemented at Saint Louis University School of Medicine

The impact of cognitive impairment in urologic implants: a narrative review.

With the general population aging and thus more patients developing bothersome erectile dysfunction, stress urinary incontinence and overactive bladder, there will likely be a higher demand for three common interactive implants in urology, the penile prosthesis, artificial urinary sphincter (AUS) and sacral neuromodulation (SNM). Further, the prevalence of mild and major neurocognitive disorders (also known as mild cognitive impairment and dementia, respectively) is expected to increase. While the aforementioned urologic implants have excellent short and long term outcomes, there are also known device issues such as malfunction or misuse that may require surgical removal and/or revision. The objective of this narrative review is to describe the association of cognitive impairment and urologic implants. We performed a search on PubMed between the years 1975-2023 for English language articles that reported on any type or severity of cognitive impairment and its association with penile prosthesis, AUS and/or SNM. While peer-reviewed published manuscripts were prioritized, abstracts that fit our search criteria were also included. Data assessing outcomes of patients with cognitive impairment who undergo placement of a urologic implant are limited. There is an association between AUS failure or misuse with cognitive impairment. SNM is efficacious in this population in the short term. In patients who develop dementia, an inflatable penile prosthesis can be deflated via in-office needle puncture and an AUS can be deactivated. The Memory Alteration Test, Quick Screen for Mild Cognitive Impairment and the Saint Louis University Mental Status Examination are relatively quick screening tests with good sensitivity and specificity for mild cognitive impairment. While data on the association between urologic implants and cognitive impairment are sparse, there are tools that urologists can use to screen patients for cognitive impairment. With screening, urologists can provide appropriate preoperative counseling (including recommending against implantation) and can provide closer postoperative monitoring. Further study is required to assess which patients should be excluded from device implantation and how to properly assess for cognitive impairment in a manner that is both beneficial for the patient and convenient and efficient for a urologist.

Differences in Medication Use by Gender and Race in Hospitalized Persons Living with Dementia.

The purpose of this study was to describe differences in treatment of White versus Black older adults, males versus females, and those living at home, assisted living, or nursing home communities with regard to the use of psychotropic, pain, and cardiovascular medications. Baseline data from the first 352 participants in the study, implementation of Function-Focused Care for Acute Care Using the Evidence Integration Triangle, were used. Data included age, gender, race, comorbidities, admission diagnosis, and living location prior to hospitalization, the Saint Louis University Mental Status exam, the modified Charlson Comorbidity Index, the Pain Assessment in Advanced Dementia scale, the Confusion Assessment Method, and medications prescribed. Generalized linear mixed model analyses were done, controlling for race or gender (depending on which comparison analysis was being done), age, cognitive status, hospital, delirium, and comorbidities. Medication use was significantly higher for White older adults, compared to Black older adults, for antidepressants, anxiolytics, non-opioid pain medications, and opioids and lower for antihypertensives. Females received more anxiolytics than their male counterparts. There were differences in medication use by living location with regard to non-opioid pain medication, antipsychotics, statins, and anticoagulants. The findings provide some current information about differences in medication use across groups of individuals and can help guide future research and hypothesis testing for approaches to minimizing these differences in treatment.

How accurate is hemoglobin A1c in diagnosing diabetes in children?

Saint Louis University (Southwest Illinois) Family Medicine Residency Program, O'Fallon, IL The corresponding author is Christopher Weisgarber; [email protected] The authors declare no conflicts of interest.

Isolated thoracic and lumbar transverse process fractures: Do they need spine surgeon evaluation? a high volume level I trauma center experience with cost analysis

BackgroundTransverse process fractures (TPF) of the thoracic and lumbar spine have become increasingly identified due to CT imaging. Spine service consultation is common for further evaluation and management. There are several studies that demonstrate no difference in clinical outcome with or without spine service intervention. However, no study to our knowledge provides an additional cost analysis. We hypothesize that isolated thoracolumbar TPF are stable injuries. Furthermore, spine service consultation and evaluation results in increased health care costs. MethodsPatients were identified using trauma registry data at Saint Louis University (SLU) from January 2012 to August 2018. Chart and imaging review was performed to determine if additional spine fractures were identified by the spine team which were not included in the initial radiology report. TPF associated with other spinal injuries were defined as one or more thoracic and/or lumbar TPF in addition to any other acute fracture or dislocation in the cervical, thoracic, or lumbar spine. A separate cost analysis with institution-specific charges was also performed. ResultsSix hundred eighty-two patients with TPF from January 2012 to August 2018 were identified. Two hundred twenty-eight patients met the criteria to be included in this study. Additional spinal pathology that was not included in the initial radiology report was identified in 5 (2.19%) patients, none of which required surgical intervention. Cost analysis demonstrated additional costs associated with spine service intervention totaled $1,725,360.28. Average cost per patient in our cohort summed to $2,529.85 ConclusionsThese data support that isolated TPF of the thoracic and lumbar spine are stable injuries that likely do not require spine service intervention and in fact may represent unnecessary financial burden. Foregoing unnecessary consultation can alleviate time constraints within spine service practices and reduce health care costs by eliminating costly extraneous interventions from the patient's care.

#5742 MID-ARM CIRCUMFERENCE AS A CORRELATE TO DIFFERENT: ASPECT NEUROCOGNITIVE IMPAIRMENT IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Malnutrition is associated with poor cognitive function (CI) in Hemodialysis (HD) patients. Both have multiple ways of assessment scaled from simple bedside screening tests to more sophisticated time- and cost-consuming measures. This work aims to define the best nutritive assessment measure that correlates to the degree of CI. Method A cross-sectional study was carried out on 116 patients in 4 different HD units from Delta Nile, Egypt. The nutritional status was examined after the dialysis session in euvolemic patients using (1) anthropometric measurements, including body mass index (BMI), mid-arm circumference (MAC), skin fold thickness (SFT), and mid-arm muscle circumference (MAMC); (2) bioelectrical impedance analysis for assessment of skeletal muscle mass (SMM), skeletal muscle index (SMI), free fat mass (FFM), body fat mass (BFM), and total body water (TBW); (3) Hand grip strength was used to assess muscle power. The assessment of cognition was made using (1) a mini-mental state examination (MMSE) for orientation, registration, attention, recall, language, and copying; (2) Saint Louis University Mental Status Exam (SLUMS) for early CI and executive functioning; (3) Arabic version of Penn Web-Based Computerized Neurocognitive Battery (WebCNP) for those who scored no CI in the previous two tests. Results The results of MMSE and SLUMS tests showed that 34.5% of our cohort (n = 40) had no CI, 34.5% (n = 40) had mild to moderate degrees of CI, and 31% (n = 36) had a severe form of CI. Comparing the nutritional assessment parameters between the categories of cognitive scores revealed that there were no significant differences except in significantly lower median values of MAC (P 0.01), SMI in bioelectrical impedance analysis (P0.01), and hand grip strength (P 0.002) in severe CI group than the normal to patients without CI. In correlation statistics, MAC and hand grip strength were negatively correlated to the degree of CI (r = -0.3, P 0.006 and r = -0.26, P 0.009, respectively). MAC was the only parameter correlated with attention, emotional recognition, and differentiation functioning in the forty patients with no CI who underwent computerized neurocognitive assessment. The highest reported positive correlations reported were between the MAC and response time of both emotion recognition (r = 0.57, P &amp;lt;0.001) and differentiation (r = 0.55, P &amp;lt;0.001). Conclusion Of the different parameters of nutritional state assessment, MAC, the simple bedside measurement, was the best correlate with the degree of cognitive impairment in HD patients, even in its mild primitive forms.

#6917 IMPACT OF FUNCTIONAL IRON DEFICIENCY IN NON-ANEMIC HEMODIALYSIS PATIENT ON NEUROCOGNITIVE AND QUALITY OF LIFE: A SINGLE CENTER CROSS-SECTION STUDY

Abstract Background and Aims The clinical paradox of high ferritin levels and low TSAT is a condition known as "functional iron deficiency." This occurs when the body has adequate iron stores, as indicated by high ferritin levels, but the iron is not available for use in the body, as indicated by low TSAT levels. This can be caused by inflammation, chronic disease, or other conditions that interfere with the body's ability to absorb and utilize iron. Hemodialysis patients may suffer from both absolute and functional iron deficiency. Most studies was directed to study effect of absolute iron deficiency even without anemia, and the important of supplementing with oral or intravenous iron ; however, impact of functional iron deficiency without anemia and subsequently decision of iron supplementation especially in presence of high ferritin is still undetermined. Our aim is to assess the impact of functional iron deficiency without anemia in neurocognitive function and quality of life among hemodialysis patients in dialysis unit in urology and nephrology center Mansoura University. Method Patients on regular haemodialysis were screened using complete blood picture, transferrin saturation (TSAT) and serum ferritin to determine iron status. The Saint Louis University Mental Status assessed cognitive function. (SLUMS) Examination used for detecting mild cognitive impairment and dementia. Quality of life was assessed by 36-item short-form (SF-36). The SF-36 measures eight scales: physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE), and mental health (MH). Results Among 70 patients maintained on regular hemodialysis, A 42 patients have normal hemoglobin level (above 12 mg/dl with high serum ferritin &amp;gt;300 ng/mL). They classified into two group: A 26 patients with high ferritin, high TSAT &amp;gt;20%, and normochromic red blood cells, A 16 patients with high ferritin level,low TSAT&amp;lt;20% and hypochromic red blood cells. Among the 26 patients, 17 male and 9 female, and among the 16 patients, 11 male and 5 female. The 26 patients have mean age of (41 +/- 13) and the 16 patients have mean age of (39 +/- 10). No significant difference between the two groups regarding sex and age with p value (0.5 and 0.1 respectively). Assessment of cognitive function by SLUM score revealed regarding normal group (4 have normal score, 18 have mild impairment of cognitive function and 4 have dementia score) and the iron deficient group (4 have normal score, 9 have mild impairment of cognitive function and 3 have dementia score) with no statistically different between the two group (P = .6).requarding quality of life, no statistically difference was fond between the two group regarding : physical functioning (p= 0.18), role physical (P = .11), bodily pain (p = 0.33), general health (p= 0.5), vitality (P = .41), social functioning (P = .2), role emotional (P = .4), and mental health (P = .21 ). Conclusion Non-anemic hemodialysis Patients with Functional iron deficiency has no statistically difference regarding neurocognitive function and quality of life from normal iron non-anemic patients.

Cognitive Function Among Rural People in Nineveh: A Cross-Sectional Survey

Background: Early identification of cognitive weakening in previously undetected cases could help deal by starting programs for rehabilitation. Aim: The aim of this survey was to evaluate the prevalence and degree of cognitive impairment among adults of rural area in Nineveh, Iraq. Method: A cross-sectional study with convenient sampling technique was conducted to enroll subjects from a rural area in Nineveh. Cognitive function was examined in all the patients by the Saint Louis University Mental Status (SLUMS) is a screening tool for the cognitive state. A total of 213 agreed to participate in the survey with a mean age of 52.1 ± 11.8 years and higher percentage of participants were with primary level of education 125 (58.7%). Results: The mean score for the cognitive function examination was 18.85 ± 4.55 with significant differences were found between cognitive function and educational level, employment, and monthly income. Cognitive score was negatively correlated with age of participants (r= - 0.128, p value = 0.031). Although it was not significantly associated with level of education but around 43% of the study population suffered from mild cognitive impairment to dementia. Conclusion: The study concludes that there have been strong calls for program from the Ministry of Health to improve dementia care and support for societies with dementia and their occupations that will stay a life of that means and dignity. Efforts to make societies greater cognitively functioned, as well as, actively attractive patients will improve cost, the sustainable, treatment and care methods for diseases and quality of life.

The Healthcare Provider Burden Scale: Short Form.

Journal Article Accepted manuscript The Healthcare Provider Burden Scale: Short Form Get access Raymond C Tait, Ph.D, Raymond C Tait, Ph.D Saint Louis University School of Medicine Correspondence should be sent to Raymond C. Tait, Ph.D., Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 S. Grand Blvd., St. Louis, MO, 63105, U.S.A. Email: raymond.tait@health.slu.edu. Search for other works by this author on: Oxford Academic PubMed Google Scholar John T Chibnall, Ph.D John T Chibnall, Ph.D Saint Louis University School of Medicine Search for other works by this author on: Oxford Academic PubMed Google Scholar Pain Medicine, pnad056, https://doi.org/10.1093/pm/pnad056 Published: 08 May 2023 Article history Received: 14 March 2023 Revision received: 26 April 2023 Accepted: 04 May 2023 Published: 08 May 2023

Evaluation of interactions between nesfatin-1 and B lymphocytes

The function of nesfatin-1, corresponding to the nucleobindin2 (NUCB2) precursor, was first identified in the hypothalamic nuclei, and was reported to be potently anorexigenic (Oh-I et al. 2006). More recently it has been shown that expression of Nesfatin-1 is not restricted locally to the hypothalamus but is widely expressed in many peripheral tissues, including adipose tissue, and associated with a range of physiological effects. For example, when Nesfatin-1 is genetically knocked out ( Nucb2-/-) in mice fed a high fat diet there is a resultant increase in the gene expression of pro-inflammatory mediators and cytokines, including Tlr4, in the subcutaneous white adipose tissue compared to WT animals also fed a high fat diet. These data support that Nesfatin-1 has anti-inflammatory properties, but the mechanistic actions of this peptide in this setting have yet to be fully described (Gharane et al. 2022). To begin to evaluate the interactions of Nesfantin-1 and immune cells more in depth we began with B lymphocytes where Nubc2, the Nesfatin-1 precursor, was originally identified (Miura et al. 1993). Using an immortalized B lymphocyte cell line, Raji, and primary cells from human donors we determined the ability of Nesfatin-1 to bind to the cell surface and affect B lymphocyte proliferation. Furthermore, we determined if treatment with Nesfatin-1 is sufficient to protect against toll like receptor-4 (TLR4) and B cell receptor (BCR) induced cytokine and antibody release from B lymphocytes. This work is the beginning characterization of a novel interaction between Nesfatin-1 and B cells. Given the anti-inflammatory activity of Nesfatin-1 and its potential direct effects on immune cells, there is a broader impact for this work in protection during chronic inflammation caused by obesity and metabolic disorders. Saint Louis University This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Vitamin A deficient mice exhibit impaired viral clearance, increased inflammation and altered immune response during respiratory viral infection

Abstract Vitamin A deficiency (VAD) is prevalent in developing countries and is associated with increased mortality after respiratory viral infections. Vitamin A can only be acquired through the diet, and millions of pregnant women and young children are deficient; however, the effects of VAD on the immune response are not completely understood. Pregnant C57BL/6 mice were placed on a VAD diet at gestational day five, pups remained on this diet after birth. At 8 weeks of age, control and VAD mice were infected intranasally with a sub-lethal dose of Sendai Virus (SeV), a natural mouse pathogen. Body weight loss in control mice peaked at day 7 post-infection, while VAD mice continued to lose weight until day 11 post-infection. This was associated with delayed clearance of virus, elevated cytokines TNFα, IL-4, and IL-17, and increased numbers of inflammatory cells in the VAD lungs. Flow cytometry showed significantly increased percentages of neutrophils on days 7 and 21, increased NK cells on day 7, increased macrophages on day 7 and increased MHC Class IIhi macrophages on days 7 and 21. In the adaptive response, CD4+ and CD8+ T cells were decreased on day 7 and increased on day 21. CD4+ T cell subsets showed increased CD4+Foxp3+ T cells on day 7 and increased CD4+Tbet+ T cells on day 21. B lymphocytes were lower at all time points. Together, this suggests that VAD affects multiple cell populations in both the innate and adaptive immune responses to viral infection in the lung, Supported by Grants from Sigma Xi Grant in Aid of Research, Saint Louis University College of Arts and Sciences Knoedler Award, and Saint Louis University College of Arts and Sciences Graduate Undergraduate Award.

Neuronostatin accts as a counterregulatory factor to protect against hypoglycemia

Neuronostatin (NST) is a 13-amino acid hormone derived from the somatostatin (SST) preprohormone that exerts metabolic and cardiovascular actions in many tissue types. In transformed alpha cell lines and isolated rat islets neuronostatin enhanced low glucose-stimulated proglucagon transcription and glucagon secretion1. Additionally, neuronostatin inhibited high glucose-stimulated insulin secretion from isolated rat islets, which was mirrored in vivo in rats subjected to an intra-arterial glucose tolerance test. Rats that received a bolus injection of neuronostatin followed by infusion glucose exhibited delayed glucose disposal and impaired insulin release, causing an increased peak blood glucose1. We, therefore hypothesized the ability of neuronostatin to act as a counterregularoty factor to protect against hypoglycemia. We found that Neuronostatin administered prior to an insulin tolerance test significantly reduced hypoglycemia compared to the saline control. In addition, we found that administration of exogenous Insulin significantly reduced Neuronostatin plasma levels. These data suggest Neuronostatin may act as a counterregulatory factor in adult, male rats to prevent hypoglycemia. However, after menopause or OVX, a precipitous decline in insulin sensitivity parallels an increase in fat mass, suggesting estrogens at physiological concentrations may maintain insulin action and glucose tolerance. We therefore investigated the neuronostatin-induced blood glucose changes in conscious, cycling females. We found blood glucose levels following neuronostatin administration decreased on diestrus, when both estrogen and progesterone levels are low, but not on proestrus or estrus. From these data we conclude that the metabolic actions of Neuronostatin are modulated by sex hormone status. Further studies are required to determine the contributions of chromosomal sex and individual sex hormones to these metabolic effects of Neuronostatin.1. Salvatori AS, Elrick MM, Samson WK, Corbett JA, Yosten GL. Neuronostatin inhibits glucose-stimulated insulin secretion via direct action on the pancreatic alpha-cell. Am J Physiol Endocrinol Metab. 2014;306:E1257–E1263. Saint Louis University Internal Funds This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.