Severe Group Research Articles

A comprehensive evaluation on the associations between hearing and vision impairments and risk of all-cause and cause-specific dementia: results from cohort study, meta-analysis and Mendelian randomization study.

Epidemiological studies show inconsistent links between hearing/vision impairment and dementia risk. Using multisource data, we investigated how single or combined sensory impairments relate to risks of all-cause and specific types of dementia. We employed a triangulation approach combining three methodologies. We analyzed 90,893 UK Biobank (UKB) adults to explore single and joint effects of hearing and vision impairments on all-cause and Alzheimer's disease (AD), vascular dementia (VD) and non-AD non-VD (NAVD). A meta-analysis of prospective studies involving 937,908 participants provided stronger evidence. Finally, we conducted Mendelian randomization (MR) analysis using genome-wide association studies from UKB (361,194 participants) and FinnGen (412,181 participants) to validate relationships between sensory impairments and dementia occurrence. In the UKB cohort study, compared to participants with normal hearing, those in the mild and severe hearing impairment groups had progressively and significantly higher risk of all-cause dementia (mild: HR1.52, 95%CI 1.31-1.77; severe: HR1.80, 95%CI 1.36-2.38), AD (mild: HR1.63, 95%CI 1.30-2.04; severe: HR2.18, 95%CI 1.45-3.27), VD (mild: HR1.68, 95%CI 1.19-2.37; severe: HR1.47, 95%CI 1.22-1.78), and NAVD (mild: HR1.47, 95%CI 1.22-1.78; severe: HR1.98, 95%CI 1.43-2.75). Besides, vision impairment was associated with an increased risk of all-cause dementia (HR1.55, 95%CI 1.18-2.04) and NAVD (HR1.51, 95%CI 1.07-2.13). Furthermore, dual sensory impairment was associated with stepwise increased risks of all-cause and cause-specific dementia than single hearing or vision impairment. In the meta-analysis of 31 prospective cohort studies, risks of all-cause dementia and AD were elevated in participants with single hearing impairment (all-cause dementia: HR1.30, 95%CI 1.21-1.40; AD: HR1.30, 95%CI 1.21-1.40) and dual sensory impairment (all-cause dementia: HR1.63, 95%CI1.14-2.12; AD: HR 2.55, 95%CI 1.19-3.91), while single vision impairment only associated with higher risk of all-cause dementia (HR1.43, 95%CI 1.16-1.71) but not AD. Finally, the MR analysis revealed a significant association between hearing impairment and all-cause dementia (OR1.74, 95%CI 1.01-2.99), AD (OR1.56, 95%CI 1.09-2.23), and NAVD (OR1.14, 1.02-1.26), as well as vision impairment and NAVD (OR1.62, 95%CI 1.13-2.33). Our findings showed significant associations between hearing and vision impairments and increased risks of all-cause and cause-specific dementia. Standardized hearing and vision assessment and intervention should be emphasized in dementia prevention strategies.

Update of prognosis and characteristics of chronic obstructive pulmonary disease in a real-world setting: a 5-year follow-up analysis of a multi-institutional registry.

We conducted a prospective observational study to elucidate the long-term prognosis and management of chronic obstructive pulmonary disease (COPD) in clinical practice in Japan in the mid-2010s. This prospective cohort study included 29 facilities. Data from 427 patients clinically diagnosed with COPD, enrolled between September 2013 and April 2016, were analyzed. Interstitial pneumonia was excluded through a central multidisciplinary discussion. Follow-up data were collected for up to 5 years after patient registration. At the time of registration, 53 patients clinically diagnosed with COPD did not have airflow limitation (AFL). In the cohort with AFL (n = 374), 232 patients completed a 5-year follow-up, while 49 patients died during the 1576.6 person-years of observation. The mean age was 71.7 years with an overall 5-year survival rate of 85.4%. Stratified by % forced expiratory volume in one second (FEV1), survival rates were 93.6% in the mild and moderate AFL group, 82.5% in the severe AFL group, and 66.1% in the very severe AFL group. The prognosis of the subpopulation without AFL was poor with a 5-year survival of 81.6%. This subpopulation exhibited respiratory symptoms, low vital capacity and total lung capacity, and emphysematous changes. Our study presents the 5-year survival and real-world clinical practice scenario of a prospective cohort of patients clinically diagnosed with COPD in Japan in the mid-2010s. The survival rates of our cohort were numerically better than the Japanese cohort in the 1990s, regardless of the high median age of this cohort. Overall, 12.4% of the patients in this cohort with no AFL at registration exhibited respiratory symptoms and distinct spirometric patterns, and had a poor prognosis.

Dynamic Changes in Lymphocyte Populations and Their Relationship with Disease Severity and Outcome in COVID-19

Studies suggest that the dynamic changes in cellular response might correlate with disease severity and outcomes in SARS-CoV-2 patients. The study aimed to investigate the dynamic changes of lymphocyte subsets in patients with COVID-19. In this regard, 53 patients with COVID-19 were prospectively included, classified as mild, moderate, and severe. The peripheral lymphocyte profiles (LyT, LyB, and NK cells), as well as CD4+/CD8+, CD3+/CD19+, CD3+/NK and CD19+/NK ratios, and their dynamic changes during hospitalization and correlation with disease severity and outcome were assessed. We found significant differences in CD3+ lymphocytes between severity groups (p < 0.0001), with significantly decreased CD3+CD4+ and CD3+CD8+ in patients with severe disease (p < 0.0001 and p = 0.048, respectively). Lower CD3+/CD19+ and CD3+/NK ratios among patients with severe disease (p = 0.019 and p = 0.010, respectively) were found. The dynamic changes of lymphocyte subsets showed a significant reduction in NK cells (%) and a significant increase in CD3+CD4+ and CD3+CD8+ cells in patients with moderate and severe disease. The ROC analysis on the relationship between CD3+ cells and fatal outcome yielded an AUC of 0.723 (95% CI 0.583–0.837; p = 0.007), while after addition of age and SpO2, ferritin and NLR, the AUC significantly improved to 0.927 (95%CI 0.811–0.983), p < 0.001 with a sensitivity of 90.9% (95% CI 58.7–99.8%) and specificity of 85.7% (95% CI 69.7–95.2%). The absolute number of CD3+ lymphocytes might independently predict fatal outcomes in COVID-19 patients and T-lymphocyte subset evaluation in high-risk patients might be useful in estimating disease progression.

Cribriform Pattern Is a Predictive Factor of PSA Recurrence in Patients Receiving Radiotherapy After Prostatectomy.

In prostate cancer, robotic total prostatectomy is a popular treatment modality. However, prostate-specific antigen (PSA) recurrence after prostate cancer surgery remains a concern. Salvage radiotherapy is commonly used to treat PSA recurrence, but the recurrence rate after salvage radiotherapy is high, highlighting the need for better predictive markers. This study aimed to retrospectively evaluate the association between cribriform pattern and PSA recurrence in patients receiving radiotherapy after radical prostatectomy. Data of 50 patients who underwent radiotherapy after total prostatectomy between January 2010 and May 2020 were retrospectively evaluated. The median age was 67 years. Among these patients, two cases involved postoperative irradiation, while 48 cases involved salvage irradiation after postoperative PSA recurrence. The median time from surgery to PSA recurrence was 38.3 months. The median radiation dose was 64 Gy in 32 fractions. Three-dimensional conformal radiation therapy was administered in 38 cases and intensity-modulated radiation therapy was used in 12 cases. Combined hormone therapy was administered in 21 cases. PSA levels were measured every 3 months after treatment. Statistical analysis between groups was performed by a t-test. The median follow-up period after radiotherapy was 31 months. No local recurrences were observed at the prostate bed, and no deaths related to prostate cancer were recorded during follow-up. However, 18 patients (36.0%) had PSA recurrence. The PSA recurrence rate based on the cribriform pattern was 17.6% in the none to moderate group (34 patients) and 75.0% in the severe cribriform pattern group (16 patients). The PSA recurrence rate was significantly higher in patients with a severe invasive cribriform pattern (p=0.001). No significant differences were observed in other histopathological characteristics. The cribriform pattern in surgical pathology specimens was found to be a useful predictor of PSA recurrence after postoperative radiotherapy.

Correlation between severity of preoperative low back pain and postoperative outcomes in lumbar disc herniation surgery: A retrospective cohort study.

BACKGROUND CONTEXTLow back pain (LBP) frequently occurs in patients with lumbar disc herniation (LDH), however the extent to which discectomy ameliorates it and how preoperative LBP influences postoperative outcomes remains unclear. PURPOSETo evaluate the improvement in LBP and its impact on postoperative patient-reported outcome measures (PROMs). STUDY DESIGN/SETTINGMulticenter retrospective observational study. PATIENT SAMPLEPatients undergoing discectomy for LDH at eight hospitals from April 2017 to March 2021. OUTCOME MEASURESData were collected on patients’ backgrounds, operative factors, and PROMs, including the Numeric Rating Scale (NRS) for pain in the low back, buttock, or leg, EuroQol 5 Dimension (EQ-5D), Oswestry Disability Index (ODI) scores, and postoperative satisfaction. METHODSPatients were categorized into mild (NRS 0–3), moderate (NRS 4–7), or severe (NRS 8–10) LBP groups. Inverse probability weighting with propensity scores was used to adjust for demographic and clinical differences between groups. Chi-square tests and one-way analysis of variance were conducted to compare background data and clinical characteristics. Additionally, multivariate logistic regression was performed to identify risk factors for less than 50% improvement in LBP. RESULTSThis study included 928 patients: 270 mild, 343 moderate, and 315 severe. After adjustment, preoperative NRS scores were significantly different across groups, with scores of 1.6 (SD 1.3), 5.6 (SD 1.0), and 8.8 (SD 0.9), respectively. Postoperative NRS scores also varied significantly, with worse outcomes observed in the severe group compared to the mild group, yet similar to the moderate group. A total of 46.8% of the mild group, 86.6% of the moderate group, and 72.9% of the severe group achieved a 50% decrease in NRS scores of LBP. Preoperative EQ-5D and ODI scores were significantly worse in the severe group compared to the mild or moderate groups, but postoperative scores were not significantly different between the severe and moderate groups. No significant differences in postoperative satisfaction were observed among the groups. Being female was a significant risk factor for less than 50% improvement in LBP (odds ratio = 1.56, p = 0.022). CONCLUSIONSDiscectomy significantly improved LBP in patients with LDH, including those with moderate or severe LBP. Patients with severe LBP showed similar improvements in PROMs as those with moderate LBP. Female gender emerged as a significant risk factor for less than optimal improvement in LBP.

Intravenous immunoglobulin‑based adjuvant therapy for severe fever with thrombocytopenia syndrome: A single‑center retrospective cohort study.

Intravenous immunoglobulin (IVIG) is frequently administered to patients with severe fever with thrombocytopenia syndrome (SFTS), particularly those with severe manifestations, although its efficacy remains controversial. The study retrospectively analyzed the effects of IVIG administration on SFTS patients in both mild and severe groups. The primary outcome measure was 28-day mortality. Inverse probability of treatment weighting (IPTW) with propensity score was used to account for baseline confounders. A total of SFTS patients with complete data enrolled from January 1, 2015, to August 1, 2023. Death at 28 days occurred for 68 (17.5%) patients. By unadjusted analysis, no difference was observed for 28-day mortality between the IVIG and non-IVIG groups in both the mild and severe groups. Similar results were found by propensity score matching and by IPTW analysis. Although IVIG is frequently used as adjuvant therapy for severe SFTS patients, no significant association was observed between IVIG treatment and reduced mortality in this patient population.

Correlation of Impulse oscillometry system indices with conventional pulmonary function tests in patients with obstructive pulmonary ventilation dysfunction

Objective: To investigate the correlation between impulse oscillometry system examination indicators and conventional pulmonary ventilation function. Methods: The pulmonary ventilation function data of 10 883 patients from January 1, 2020 to December 31, 2022 at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were included. The one-second rate [ratio of forced expiratory volume in the first second (FEV1) to forced vital capacity (FVC)] measured as a percentage of the predicted value was ≥92% for the control group (n=3 478) and <92% for the pulmonary obstruction group (n=7 405). The obstruction group was subdivided into five groups according to the degree of pulmonary dysfunction: mild group (n=3 938),moderate group (n=1 142),oderate-severe group (n=917),severe group (n=737),and extremely severe group (n=671). Conventional pulmonary ventilatory function FVC, FEV1, one-second rate, and forced expired flow at 50% of FVC (MEF50%), forced expired flow at 75% FVC (MEF25%), maximal mid-expiratory flow (MMEF), peak expiratory flow (PEF), and pulsed oscillation pulmonary function test were detected in both groups of patients. Impedance at 5 Hz (Z5) means total respiratory resistance, resistance at 5 Hz (R5) means total airway resistance, reactance at 5 Hz (X5) indicates the elastic recoil of the peripheral airways, and resistance at 20 Hz (R20) represents resistance of the central airways. R5-R20 reflects resistance in the small airways. Additionally, peripheral resistance (Rp), respiratory resonance frequency (Frex), and area under the reactance curve (Ax) were also measured. Correlation between the indicators of the two groups and the sensitivity and specificity of the impulse oscillometry system parameters for the diagnosis of obstructive pulmonary ventilation dysfunction were analyzed. Results: Pulmonary function force expiratory volume in the first second as a percentage of predicted value (FEV1%Pre) [80.10 (54.95,97.10)%],one-second rate [62.43(48.67, 67.02)%],MEF50% [1.33 (0.62,1.97)L/s],MEF25% [0.28 (0.17,0.41)L/s], MMEF [0.85 (0.43,1.29)L/s],and PEF [5.64 (3.73,7.50)]L/s in the obstruction group were significantly lower than those in the control group (P<0.05). The differences within the subgroups of the obstruction group were also significant (P<0.05). Pulsed oscillation Z5 [0.42 (0.33,0.55)kPa·L-1·s-1],Rp [0.25 (0.20,0.45)kPa·L-1·s-1], R5 [0.39 (0.31,0.49)kPa·L-1·s-1], R20 [0.28 (0.24,0.34)kPa·L-1·s-1], R5-R20 [0.09 (0.05,0.17)kPa·L-1·s-1],Frex [16.32 (13.07,20.84)Hz], and Ax [0.67 (0.28,1.64)] indices in the obstruction group were significantly higher than those in the control group. X5 [-0.14 (-0.23, -0.10)kPa·L-1·s-1] was significantly lower than that in the control group (P<0.05). Z5, Rp, X5, R5, R5-R20, Frex, and Ax were statistically significant between different degrees of obstruction in the obstruction group (P<0.05). The impulse oscillometry system parameters Z5, Rp, R5, R20, R5-20, Frex, and Ax were negatively correlated with the indices of conventional pulmonary ventilation (r=-0.21-0.68, P<0.05), and the parameter X5 was positively correlated with the indices of conventional pulmonary ventilation (r=0.41-0.68, P<0.05). The pulsed oscillation pulmonary function test parameters X5 (58.60%-95.68%) and Ax (57.08%-98.06%) presented the best sensitivity; X5 (86.29%-98.82%), Frex (86.69%-94.71%), and Ax (88.10%-98.53%) displayed the best specificity; and R20 presented the worst sensitivity and specificity. The sensitivity and specificity were slightly better in female patients than in male patients. Conclusion: The technical parameters of the impulse oscillometry system showed significant correlation with relevant indices of conventional pulmonary ventilation function detection. These well reflect the changes of different degrees of pulmonary ventilation function and have greater significance for reference in evaluating the degree of pulmonary function impairment.

Costs of Care in Relation to Alzheimer's Disease Severity in Sweden: A National Registry-Based Cohort Study.

The advancement of diagnostic and therapeutic interventions in early Alzheimer's disease (AD) has demanded the economic evaluation of such interventions. Resource utilization and cost estimates in early AD and, more specifically, the amyloid-positive population are still lacking. We aimed to provide cost estimates in AD in relation to disease severity and compare these with the control population. We also aimed to provide cost estimates for a subset of the AD population with both clinical diagnosis and amyloid-positive confirmation. This was a retrospective longitudinal analysis of resource utilization using data from national registries. A cohort from the national Swedish registry for cognitive/dementia disorders (SveDem) includes all clinically diagnosed AD between 2013 and 2020. The study population included 31,951 people with AD and 63,902 age- and sex-matched controls (1:2). The population was followed until death, the end of December 2020, or 2years from the last clinic visit. Direct medical and social costs were estimated from other national registries. Direct medical costs include costs for medications and inpatient and outpatient clinical visits. Direct social costs include costs for institutionalization, home care, short-term care, support for daytime activities, and housing support. Mean annual costs and 95% confidence intervals were obtained by bootstrapping, presented in 2021 Swedish Krona (SEK) (1 SEK=0.117 USD, 1 SEK=0.0985 EUR in 2021), and disaggregated by AD severity, cost component, sex, age group, and care setting. Mean annual costs for individuals with clinically diagnosed AD were SEK 99,906, SEK 290,972, SEK 479,524, and SEK 795,617 in mild cognitive impairment (MCI), mild, moderate, and severe AD. The mean annual costs for the population with both clinical diagnosis and amyloid-positive AD confirmation (N=5610) were SEK 57,625, SEK 179,153, SEK 333,095, and SEK 668,073 in MCI, mild, moderate, and severe AD, respectively. The mean annual costs were higher in institutionalized than non-institutionalized patients, females than males, and older than younger age groups. Inpatient and drug costs were similar in all AD severity stages, but outpatient costs decreased with AD severity. Costs for institutionalization, home care, support for daytime activities, and short-term care increased with AD severity, whereas the cost of housing support decreased with AD severity. This is the first study estimating annual costs in people with AD from MCI to severe AD, including those for the amyloid-positive population. The study provides cost estimates by AD severity, cost components, care settings, sex, and age groups, allowing health economic modelers to apply the costs based on different model structures and populations.

Doxycycline with or without famciclovir for infectious ophthalmic and respiratory disease: a prospective, randomized, masked, placebo-controlled trial in 373 kittens.

The aim of this study was to prospectively evaluate in a randomized, triple-masked, placebo-controlled trial, outcomes for kittens with ocular manifestations of infectious upper respiratory disease (IURD) treated with an ophthalmic and oral antibiotic only vs those also treated with famciclovir. Kittens were stratified into three age (1 to <4, 4 to <8 or 8-12 weeks) and two disease severity ('mild' [total disease score 1-11] or 'severe' [total disease score 12-23]) groups and randomized to receive approximately 5 mg/kg doxycycline either with placebo (group D) or with approximately 90 mg/kg famciclovir (group DF) PO q12h. Caregivers scored clinical signs once daily for 21 days. Ophthalmic examinations and scoring by veterinarians were completed on days 1 and 21. Ophthalmic and clinical resolution were defined as scores of zero for all ocular signs and all ocular and respiratory signs, respectively. Ophthalmic and clinical recovery were defined by absence of active inflammation. For kittens with mild disease, those in group D were slower than those in group DF to achieve clinical recovery (P = 0.049) and clinical resolution (P = 0.030), but not ophthalmic recovery (P = 0.064) or ophthalmic resolution (P = 0.089). Kittens with mild disease and receiving famciclovir achieved predicted 75% clinical resolution 4-5 days earlier than kittens with mild disease and receiving doxycycline alone, and kittens with severe disease (regardless of treatment group). Significantly fewer kittens in group DF developed corneal disease than in group D (P = 0.016). All five kittens whose clinical signs worsened sufficiently to be removed from the study were in group D. The addition of famciclovir to standard antibiotic treatment may reduce corneal disease, length of stay and time to adoption for shelters and rescue groups, thereby increasing capacity for care. Early administration of famciclovir in kittens exhibiting mild ocular manifestations of IURD may be preferable to delaying this treatment until the disease progresses to a severe stage.

Sex-Specific Associations Between Leucocyte Measures and Obstructive Sleep Apnea in Han Chinese.

White blood cell (WBC) and its subset counts are standard, inexpensive, direct markers of inflammation. Obstructive sleep apnea (OSA) is implicated in changes in inflammation markers, and sex differences are evident in both OSA and inflammation. It is unknown whether sex modulates the relationship between OSA severity and leukocyte measures. 1222 patients (914 males, 308 females) underwent overnight laboratorial polysomnography and measurement of WBC and its subset (lymphocyte, neutrophil, monocyte) counts. Patients were divided into primary snoring and mild, moderate, and severe OSA groups, and differences in leukocyte parameters were analyzed separately by sex in multivariable analyses. In multiple regression models, higher apnea-hypopnea index (AHI) was independently associated with neutrophil counts only in men, and with higher total WBC, lymphocyte and monocyte counts both in women and men. Further ordinal logistic regression analysis revealed a significant association between AHI and total WBC (OR 1.87, 95% CI 1.09-3.23) and neutrophil (OR 1.77, 95% CI 1.02-3.07) counts in men only. Correlation analysis also revealed more robust relationships between leukocyte measures and cardiometabolic risk markers in men than in women. This study provides novel data suggesting a significant association between neutrophil count and OSA severity only in men but not women. Similarly, the relationship between leukocyte parameters and cardiometabolic risk markers were more pronounced in men than women. Our findings suggest a sex-specific impact of OSA on leukocyte measures and on their relationship with indices of cardiometabolic risk.

Differential gene expression of immune response in COVID-19 and its relationship with progression of COVID-19

Human immune response evolved in virus clearance and gene expression levels of immune response may be associated with progression of Coronavirus disease 2019 (COVID-19). Our current study aims to investigate the relationship between differential gene expression of immune response and progression of COVID-19. A total of 50 participants of COVID-19 group were studied, compared with 39 participants of healthy control group. There were different gene expression profiles in pathways of activation of neutrophil, defense response and adaptive immune response for COVID-19 group before treatment compared to the healthy control group. Distinct gene expression profiles showed that pathways of chemotaxis, immune response and antibacterial humoral response involved in rehabilitation of severe COVID-19 group while pathways of immune system process, defense response to virus and negative regulation of viral genome replication involved in rehabilitation of moderate COVID-19 group. Both protein expression of ATP-binding cassette transporter A1 levels and protein expression of low affinity Fc-receptor FcγRIIIb levels were significantly and positively correlated with COVID-19-IgM levels and might be suitable as biomarkers for monitoring of COVID-19. This study showed that differential gene expression of immune response predicted onset and rehabilitation of COVID-19.

Clinical features of and severity risk factors for COVID-19 in adults during the predominance of SARS-CoV-2 XBB variants in Okinawa, Japan.

Since 2023, COVID-19 induced by SARS-CoV-2 XBB variants have been a global epidemic. The XBB variant-induced epidemic was largest in the Okinawa Prefecture among areas in Japan, and healthcare institutions have been burdened by increased COVID-19 hospitalizations. This study aimed to evaluate the clinical features of XBB variant-induced COVID-19 and risk factors for severe COVID-19. This retrospective study included adult patients hospitalized for COVID-19 between May and July 2023 at four tertiary medical institutions in Okinawa, Japan. Patients with bacterial infection-related complications were excluded. According to oxygen supplementation and intensive care unit admission, patients were divided into two groups, mild and severe. Patient backgrounds, symptoms, and outcomes were compared between both groups, and the risk factors for severe COVID-19 were analyzed using a multivariate logistic regression model. In total of 367 patients included, the median age was 75 years, with 18.5% classified into the severe group. The all-cause mortality rate was 4.9%. Patients in the severe group were more older, had more underlying diseases, and had a higher mortality rate (13.2%) than those in the mild group (3.0%). Multivariate logistic regression analysis showed that diabetes mellitus was an independent risk factor for severe COVID-19 (95% confidence interval [CI], 1.002-3.772), whereas bivalent omicron booster vaccination was an independent factor for less severe COVID-19 (95% CI, 0.203-0.862). This study implies that assessing risk factors in older adults is particularly important in the era of omicron variants.

Ability to Select AAC Graphic Symbols by Severity of Alzheimer’s Disease and Number of Symbols

Purpose: This study aimed to examine the graphic-symbol selection ability of patients with dementia of Alzheimer's type (DAT) based on the severity of dementia by conducting symbol identification and symbol discrimination tasks with increasing numbers of symbols. These tasks were performed with both normal elderly individuals and DAT patients to explore how cognitive load affects them differently.Methods: A total of 21 normal elderly individuals, 17 mild DAT patients, and 20 moderate to severe DAT patients were assessed. They performed symbol identification and symbol discrimination tasks using the Augmentative and Alternative Communication Symbol Assessment Tool. The number of symbols increased in six steps, from 4 to 72. Accuracy and response time were measured for statistical analysis.Results: In the symbol identification task, there was no significant difference in accuracy among the three groups. However, normal group showed significantly faster responses compared to moderate to severe DAT group. In the symbol discrimination task, normal group showed higher accuracy and significantly faster responses than moderate to severe DAT group. As the number of symbols increased, response times increased across all groups, with more time required for the symbol discrimination task.Conclusion: It was confirmed that the greater the severity of DAT, the more cognitive load and impaired information processing were reflected in symbol selection. Findings suggest that response time is a more sensitive indicator of cognitive decline in DAT patients and highlight the need to adjust the number of symbols and presentation methods according to the severity of the patient’s condition in dementia interventions.

Peripapillary vessels density is closely related to cerebral white matter hyperintensities: An OCTA study.

Chronic cerebral hypoperfusion triggers the development of white matter hyperintensities (WMHs), common in cerebral small vessel disease (CSVD). However, conventional imaging techniques cannot visualize cerebral small vessels. The retina, a direct extension of the central nervous system, has an unclear correlation with WMHs. This study employs Optical coherence tomographic angiography (OCTA) to investigate vascular changes in the retina and explore its correlation with WMHs, aiming to provide a new method for assessing perfusion in early ischemic brain WMHs. Forty-nine patients with WMHs were stratified into mild and moderate/severe WMHs groups based on MRI findings, utilizing the Fazekas and Scheltens scales. OCTA assessed fundus vessel microcirculation. Logistic regression analyzed the correlation between ocular fundus microcirculation and WMH severity and location. Additionally, ROC curves evaluated the diagnostic efficacy of each fundus vascular microcirculation index in determining WMH severity. After adjusting for multiple confounders, finding consistently indicated that the moderate/ severe WMHs group exhibited lower vessel density (VD) in the superior quadrant of the inner peripapillary region compared to the mild group [OR = 0.487, CI (0.255,0.929), p < 0.05]. ROC curves revealed that when combined with age, diabetes, and superior quadrant VD of the inner peripapillary region, specificity could be increased to 94.1%. Peripapillary vessel density correlates closely with the severity of cerebral WMHs. Early morphological changes due to chronic hypoperfusion may initiate from the inner layer of the optic disc, and OCTA could offer a novel method for evaluating blood perfusion in ischemic WMHs.

Accuracy of One-Piece vs. Segmented Three-Dimensional Printed Transfer Trays for Indirect Bracket Placement

Objective: To assess the accuracy of three-dimensional (3D) printed one-piece vs. multiple segmented transfer trays for indirect bonding techniques in moderate and severe crowding cases. Methods: Eighty digital maxillary dental models were produced by an extraoral scanner. 3D-printed one-piece and segmented trays were virtually designed utilizing Maestro 3D Ortho Studio® v4 and printed using a NextDent printer. The sample was classified into two groups: Group 1 (moderate crowding) included 40 digital models with a space deficiency of 6–7 mm, and Group 2 (severe crowding) included 40 digital models with a space deficiency of 10 mm. Ortho classic brackets were then placed into the 3D printed models with the aid of the transfer trays, and the models with the final bracket positioning were scanned using iTero scanner. Four measurements were selected on each tooth to perform the analysis. Mann–Whitney and Kruskal–Wallis tests were used for comparisons. A p-value of ≤ 0.05 was considered statistically significant. Results: In the moderate crowding group, statistically significant differences were detected between the one-piece, segmented, and control groups for three measurements (p &lt; 0.001), while the rest of the measurements showed no significant differences (p &gt; 0.05). In the severe crowding group, no significant differences were detected for any of the measurements. Conclusions: One-piece and segmented 3D-printed transfer trays are considered accurate tools for indirect bonding in moderate and severe malocclusion cases. The severity of crowding did not affect the accuracy of bracket transfer in indirect bonding.

Exploring Salivary Alpha-Amylase as a Biomarker in Periodontitis: A Comparative Analysis of Disease Stages and Clinical Correlations

Periodontal disease, characterized by bacterial plaque accumulation and subsequent immune response, can lead to gingivitis and periodontitis if untreated. Salivary alpha-amylase (sAA) has emerged as a potential biomarker with implications in periodontal disease progression. Objectives: This study aimed to assess and compare salivary alpha-amylase levels in individuals with periodontitis and healthy controls and to investigate its relationship with clinical parameters of periodontal disease. Forty-five participants were categorized into periodontally healthy (n = 13), Stage I and II Periodontitis (n = 17), and Stage III and IV periodontitis (n = 15) groups. Saliva samples were collected and analyzed using ELISA kits. Statistical analyses included tests for normality, group comparisons, post hoc analysis, and correlation analysis. Significant differences in salivary alpha-amylase levels were observed among severity groups (p &lt; 0.05), with higher levels in periodontitis patients than healthy controls. Spearman correlation revealed moderate positive associations between alpha-amylase levels and probing depth (PD) and clinical attachment loss (CAL). Elevated salivary alpha-amylase levels were found to be associated with more severe periodontal disease, suggesting its potential as a biomarker for periodontitis severity. These findings support the utility of salivary biomarkers in periodontal disease diagnosis and monitoring, although further validation and standardization are warranted for clinical application.

Impact of Open-Angle Glaucoma Severity on Vision-Related Quality of Life: A Cross-Sectional Study in a Single Center in Indonesia

Background: Glaucoma is a progressive optic neuropathy characterized by the gradual loss of retinal ganglion cells (RGCs) and their axons, leading to irreversible visual field loss. This study aimed to investigate the relationship between the severity of primary open-angle glaucoma (POAG) and vision-related quality of life (VRQoL) in a single center in Indonesia. Methods: A cross-sectional study was conducted at the eye polyclinic of Dr. M. Djamil General Hospital, Padang, Indonesia, from June to August 2024. A total of 54 patients with POAG were included and categorized into mild, moderate, and severe groups based on their cup-to-disc ratio and visual field index (VFI). VRQoL was assessed using the Indonesian version of the National Eye Institute Visual Function Questionnaire (NEI-VFQ 25). Results: The mean VRQoL score was significantly lower in the severe group (60.63 ± 13.04) compared to the moderate (81.79 ± 10.42) and mild (85.04 ± 10.52) groups (p = 0.000). A strong negative correlation was observed between glaucoma severity and VRQoL (r = -0.667, p = 0.000). The social functioning subscale showed the strongest correlation with severity (r = -0.573, p = 0.000). Conclusion: The severity of POAG significantly impacts VRQoL, with more severe disease associated with lower QoL scores. The social functioning domain appears to be particularly affected. These findings underscore the importance of comprehensive glaucoma management that addresses not only clinical parameters but also the patient's overall quality of life.

Dopamine transporter availability based on white matter hyperintensity during early to mid-stage Parkinson's disease and multiple system atrophy: a case control study.

To evaluate the association of white matter hyperintensity (WMH) with dopamine transporter (DAT) availability in patients with early to mid-stage parkinson's disease (PD) and multiple system atrophy (MSA). The clinical and imaging data of 55 patients were collected, including 38 PD and 17 MSA patients and the clinical features of the two groups were compared. DAT specific binding ratio (SBR) were compared between severe and non-severe WMH groups, and between PD and MSA groups. The relationships of WMH with DAT availability and basic clinical characteristics were analyzed. Multiple linear regression analysis showed that age was the only significant variable showing correlation WMH. Age was the only clinical variable significantly correlated with WMH in PD patients (coefficient for periventricular white matter hyperintensity: 0.430, P = 0.007; coefficient for deep white matter hyperintensity: 0.381, P = 0.018). There was no significant correlation between WMH and SBRs and age in MSA patients. The SBR of the caudate nucleus and anterior putamen was significantly lower in the severe WMH group of patients than in the non-severe WMH group (P < 0.05). The values of the caudate nucleus, anterior putamen, and anterior putamen/posterior putamen were significantly lower in PD patients with than without severe WMH (P < 0.05), and the damage to the striatal DAT in MSA patients with severe WMH was similar to the non-severe patients (P>0.05). Patients with PD and a high WMH score had lower DAT availability. WMH affected the availability of DAT in patients with early to mid-stage PD compared to MSA.

Expression of lncRNAs NEAT1, PACERR, and GAS5 can be associated with disease activity in rheumatoid arthritis patients.

Long non-coding RNAs (lncRNAs) have long been considered molecular noise within the transcriptome, but over time it has been shown that they perform many important biological functions and are associated with various inflammatory and autoimmune diseases, including rheumatoid arthritis (RA). The aim of this study was to evaluate the association between circulating lncRNAs and RA activity. The study included 63 patients with well-established RA (median disease duration 12 years), 51.7 (13); mean (SD) aged, 88.9% women and 25 healthy controls (HCs) 51.8 (8.2) aged, 80% women. Quantitative real-time polymerase chain reaction was used to evaluate the plasma concentration levels of 6 lncRNAs: PACERR, NEAT1, HOTTIP, GAS5, MALAT1 and HIX003209. Among the tested molecules, 5 targets (PACERR, NEAT1, HOTTIP, GAS5 and HIX003209) had decreased concentration in RA patients compared to HCs. LncRNAs NEAT1, PACERR, and GAS5 showed differences between the severe disease activity group (the 28 joint disease activity score, DAS28>5.1) and HCs; (P = 0.02, P = 0.003 and P = 0.04, respectively). The multiple linear regression analysis indicated that GAS5 (P = 0.01) had the greatest impact on disease activity based on DAS28. Circulating plasma lncRNAs may be considered as supporting molecular markers associated with RA activity and may be useful in identifying disease exacerbation.

The relationship between ultrasound and electrodiagnostic findings in relation of the severity of carpal tunnel syndrome

IntroductionCarpal tunnel syndrome is the most common compression neuropathy. Grading the severity of carpal tunnel syndrome is an important factor in deciding on the type of treatment. This study aims to determine the relationships between the findings of the electrodiagnosis and ultrasonography methods based on the severity of carpal tunnel syndrome.MethodsIn this prospective clinical study, 50 patients (96 wrists) who were referred to the Physical Medicine and Rehabilitation Department of the Shohada Tajrish Hospital, Tehran, Iran (from March 2021 to November 2022) were studied. All patients with a history and clinical examination related to CTS underwent electrodiagnosis studies. Based on the results of electrodiagnosis, patients were divided into three groups: mild, moderate, and severe. All eligible patients underwent ultrasound at the cross-section of the wrist (at the level of the pisiform bone, the entrance of the canal) and the middle of the forearm.ResultsIn this study, the cross-sectional area of the median nerve was measured in 96 wrists of 50 patients with a mean age of 51.78 ± 9.80 years. The mean CSA of the median nerve in the mild, moderate, and severe groups was reported as 0.12 ± 0.03, 0.14 ± 0.02, and 0.21 ± 0.06, respectively. The mean WFR in different groups of CTS was reported as 1.85 ± 0.56, 1.93 ± 0.56, and 2.45 ± 0.49, respectively. A significant relationship between ultrasound findings, including CSA-inlet and WFR, and electrodiagnosis findings was presented (P value < 0.05).ConclusionBased on our findings, there is a statistically significant relationship between the sonographic findings, including the mean CSA-inlet and WFR, and the severity of CTS based on the electrodiagnosis study. Our findings revealed that as disease severity increases, sonographic parameters also increase significantly.