Young Subjects Research Articles

Left Atrial Myxoma Revealed by a Stroke in a Young Female Patient

Introduction: Cardiac myxoma is a primary benign tumor most often located in the left atrium and it is a rare source of cerebral stroke of young subjects.
 Case Presentation: We report the case of a young women with cardiac myxoma revelated by hemiplegia.
 The patient suddenly presented vertigo followed by a fall, a heaviness of her left body, and dysarthria.
 Brain CT tomography and magnetic resonance imaging revealed cerebral ischemia in the right Sylvian territory. Transthoracic echocardiography revealed a round cardiac mass, mobile, heterogeneous, multilobed, appended to the interatrial septum and the atrial side of the large mitral valve by wide implantation, measuring 38 x 25mm in the parasternal short axis (PSAX) and apical 4 chamber views evocative of left atrium myxoma. After the surgical resection, which was postponed for a month, the removed tumor was sent for histopathological examination. The morphological examination revealed a myxoid tumor proliferation compatible with cardiac myxoma expressing calretinin by these tumor cells in the immunohistochemical study.
 Conclusion: Left atrium myxoma is a benign cardiac tumor and a rare cause of ischemic stroke. Transthoracic echocardiography facilitates the diagnosis of this tumor which will then be confirmed by histological analysis.

Relationships between mesopic visual sensitivity and macular inner and outer retinal layer thickness in healthy younger, middle-aged and older adults.

To examine relationships between mesopic visual sensitivity measurements on microperimetry and macular inner and outer retinal layer (IRL and ORL) thicknesses in healthy younger, middle-aged and older subjects. In total, 154 healthy adults were divided into three age groups each with similar mean sensitivity. Regional retinal sensitivity (determined by mesopic fundus-controlled microperimetry) and IRL (ganglion cell-related layer) and ORL thicknesses were measured in the five subfields: central fovea (1 mm diameter) and the quadrants temporal, nasal, superior and inferior of a parafoveal ring of outer diameter 3 mm and inner diameter 1 mm. Relationships between regional sensitivity and corresponding IRL and ORL thicknesses were assessed through a univariate and multivariate linear regression model. Visual sensitivity means for each subfield differed across age groups (all p < 0.001). In each parafoveal ring quadrant, mean IRL thickness was reduced in the older eyes compared to the other groups (all p < 0.0001). In the inferior region, worse sensitivity was correlated with greater IRL thickness (p = 0.0207) in the middle-aged group and with a thicker ORL (p < 0.0001) and thinner IRL (p = 0.0003) in the older eyes (R2 = 0.51). The slopes of regression lines relating sensitivity to IRL thickness and age group (p = 0.0027) or to ORL thickness and age group (p = 0.0020) differed significantly. The relationship observed between mesopic visual sensitivity and retinal layer thickness varied with age. A worse sensitivity was related to a thicker macular IRL layer in middle-aged eyes and to a thicker ORL and thinner IRL in older eyes.

Echocardiographic Assessment of the Left Ventricle in Young Prehypertensive Nigerians.

Prehypertension is associated with an increased risk of cardiovascular morbidity and mortality. This risk could partly be explained by the early compromise in left ventricular (LV) structure and function. This study investigated the LV geometry and function in young black prehypertensive subjects. This cross-sectional descriptive study was conducted at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Echocardiography-derived LV geometry and function were assessed using standardized methods. Prehypertensive subjects had higher mean systolic blood pressure (BP) (130.78 ± 3.57 mmHg vs 111.42 ± 3.54 mmHg, P<0.001), diastolic BP (79.32 ± 4.13 mmHg vs 66.39 ± 4.42 mmHg, P<0.001), body mass index (BMI) (26.24 ± 3.45 kg/m2 vs 22.20 ± 2.21 kg/m2, P<0.001), waist circumference (WC) (86.93 ± 8.73 cm vs 76.73 ± 6.66 cm, P<0.001), fasting blood glucose (FBG) (93.84 ± 7.28 mg/dl vs 90.08 ± 6.26 mg/dl, P<0.001), and dyslipidemia (21.5% vs 6%. P<0.001) compared to normotensive subjects. LV mass index (LVMI) was greater in prehypertensive subjects compared to normotensive subjects {male (106.84 ± 12.34 g/m2 vs 76.07 ± 10.25 g/m2, P<0.001); female (92.06 ± 8.80 g/m2 vs 66.53 ± 7.21 g/m2, P<0.001)}, with abnormal LV geometry recorded in 17.5%. Linear regression analysis showed that waist circumference, systolic BP, serum creatinine level, and urea level were determinants of LVMI. The prevalence of LV diastolic dysfunction was higher in prehypertensive subjects than in normotensive subjects (14.5% vs. 0.5%, P<0.001), with systolic BP {odds ratio (OR) 0.928, confidence interval (CI) 0.834 - 0.969; P=0.016)} and diastolic BP (OR 0.832, CI 0.722 - 0.958; P=0.011) being independent predictors. This study showed that prehypertension in young Black subjects was associated with altered LV geometry and impaired diastolic function, and these changes demonstrated linear progression with increasing systolic BP.

Associations between cortisol stress responses and limbic volume and thickness in young adults: An exploratory study.

The investigation of the relationship between neural measures of limbic structures and hypothalamic pituitary adrenal axis responses to acute stress exposure in healthy young adults has so far focused in particular on task-based and resting state functional connectivity studies. Thus, the present study examined the association between limbic volume and thickness measures and acute cortisol responses to the psychosocial stress paradigm ScanSTRESS. Using Permutation Analysis of Linear Models controlling for sex, age and total brain volume, the associations between (sex-specific) cortisol increases and human connectome project style anatomical variables of limbic structures (i.e. volume and thickness) were investigated in 66 healthy and young (18-33 years) subjects (35 men, 31 women taking oral contraceptives). In addition, exploratory (sex-specific) bivariate correlations between cortisol increases and structural measures were conducted. The present data provide interesting new insights into the involvement of striato-limbic structures in psychosocial stress processing, suggesting that acute cortisol stress responses are also associated with mere structural measures of the human brain. Thus, our preliminary findings suggest that not only situation- and context-dependent reactions of the limbic system (i.e. blood oxygenation level-dependent reactions) are related to acute (sex-specific) cortisol stress responses but also basal and somewhat more constant structural measures. Our study hereby paves the way for further analyses in this context and highlights the relevance of the topic.

A Novel Index System for Assessing Ventricular-Vascular Coupling.

To explore the value of a novel ventricular-vascular coupling index (VVI) system in relation to age, gender and body mass index (BMI). A total of 239 volunteers with single-center and cross-sectional health screening were enrolled in the study. Subjects were divided according to age (young [18-44 years], middle-age [45-59 years], old [60-80 years]), gender (male, female), and BMI (overweight/obese [BMI 24], control [BMI 24]). The left ventricle end-diastolic volume (LVEDV) and left ventricle end-systolic volume (LVESV) provided the left ventricular structure index, while the TDI provided the functional index. Also derived from routine echocardiography were the effective arterial elastance (Ea), left ventricular end-systolic elastance (Ees), and VVI. The novel VVI systems were arterial velocity pulse index (AVI), left ventricular global longitudinal strain (LVGLS), and the AVI to LVGLS ratio (AVI/LVGLS). (1) Middle-age and elderly subjects had higher Ea and lower LVGLS compared to young subjects. AVI and AVI/LVGLS increased progressively from young to middle-age to old subjects. (2) Females had higher Ea, Ees and LVGLS than male subjects. No significant differences in AVI and AVI/LVGLS were observed between males and females. (3) No significant differences in Ea, Ees, VVI, AVI, LVGLS and AVI/LVGLS were observed between the overweight/obese and control groups. (4) AVI/LVGLS was negatively correlated with LVEDV and LVESV and with TDI . LVEDV, LVESV and TDI were independent predictors of AVI/LVGLS. (5) The diagnostic performance of AVI/LVGLS was higher than that of VVI in the young and middle-age groups. The diagnostic efficacy of AVI/LVGLS was higher than that of VVI in the young and old groups, and the diagnostic efficacy of AVI was higher than that of Ea. The difference in diagnostic efficacy between LVGLS and Ees was not statistically significant. The differences in diagnostic efficacy between AVI/LVGLS and VVI, AVI and Ea, and LVGLS and Ees were not statistically significant in the middle-age and old groups. The novel index system of ventricular-vascular coupling described here (AVI, LVGLS, and AVI/LVGLS) was more effective than traditional indexes in detecting differences in cardiovascular function between different ages groups. The study protocol was registered on the official website of China Clinical Trial Registration Center (ChiCTR2000035937).

OR07-03 UCP1 Expression In Human Brown Adipose Tissue Is Inversely Associated With Cardiometabolic Risk Factors

Abstract Disclosure: T. Kwok: None. L.E. Ramage: None. K.J. Suchacki: None. C. Gray: None. K. Alexandra: None. L.D. Boyle: None. R.K. Semple: None. S.I. Semple: None. T. MacGillivray: None. E.J. van Beek: None. S. Wakelin: None. R.H. Stimson: None. Brown adipose tissue (BAT) is a promising therapeutic target for obesity. 18F-Fluorodeoxyglucose positron emission tomography (18F-FDG PET) is the most commonly used imaging modality to quantify human BAT activity. 18F-FDG uptake may be reduced in obesity but insulin resistance has been suggested as a potential confounding factor. Uncoupling protein 1 (UCP1) is the key thermogenic protein in BAT and thus serves as a surrogate measure of BAT thermogenic capacity. We quantified UCP1 expression in paired BAT and white adipose tissue (WAT) samples from 141 patients undergoing elective neck surgery. UCP1 mRNA was quantified in whole tissue (n=53) and differentiated pre-adipocytes (n=88). Data are presented as mean ± SEM. Individuals with high UCP1 expression in whole BAT (&amp;gt;2 arbitrary units) were younger (44.2 ± 3.5 vs 55.7 ± 2.0 years) with lower BMI (26.5 ± 1.2 vs 30.1 ± 1.0kg/m2), waist circumference (87.9 ± 2.9 vs 101.1 ± 2.6cm), waist-hip ratio (0.86 ± 0.01 vs 0.92 ± 0.01), fat percentage (29.1 ± 2.6 vs 35.3 ± 1.7%), insulin resistance (HOMA-IR 1.44 ± 0.18 vs 2.69 ± 0.35), systolic (131 ± 6 vs 143 ± 4mmHg) and diastolic blood pressure (79 ± 3 vs 86 ± 2mmHg) (all P&amp;lt;0.05). BAT UCP1 expression was lower in subjects on beta-blockers or with existing hypertension. BAT (but not WAT) UCP1 expression correlated negatively with age (r=−0.305), weight (r=−0.374), waist circumference (r=−0.296), fat mass (r=−0.388) and BMI (r=−0.282) (all P&amp;lt;0.05). However, UCP1 levels in differentiated brown adipocytes were not associated with any of the above measurements. In multiple regression, age was the only independent predictor of high BAT UCP1 expression. Interestingly, BAT UCP1 levels were not reduced in obese subjects aged &amp;lt;40 years. To determine whether BAT activity was preserved in young obese subjects in vivo, we performed 18F-FDG-PET/MR scanning during mild cold exposure (16-17°C) in 6 normal weight (BMI 22 ± 1kg/m2) and 6 obese (BMI 32 ± 1kg/m2) age-matched (22 ± 1 years) subjects. BAT 18F-FDG uptake (standard uptake value 5.1 ± 0.5 vs 4.2 ± 0.6 g/mL) and volume (69 ± 14 vs 72 ± 32 cm3) were similar between weight groups, despite greater insulin resistance in obese subjects (fasting glucose 5.5 ± 0.2 vs 4.3 ± 0.1mmol/L, insulin 11.9 ± 1.3 vs 5.8 ± 0.9mU/L, HOMA-IR 2.9 ± 0.3 vs 1.1 ± 0.2, free fatty acids 465 ± 78 vs 240 ± 34µM, all P&amp;lt;0.05), suggesting that 18F-FDG uptake by BAT is not significantly affected by insulin resistance. In conclusion, BAT UCP1 expression is reduced in individuals with adverse cardiometabolic risk factors, but these subjects retain brown pre-adipocytes with the capacity to form new thermogenic adipocytes after appropriate stimulation. UCP1 expression and cold-induced 18F-FDG uptake by BAT is preserved in young obese subjects. These data highlight the therapeutic potential of BAT mass expansion and activation as a therapeutic strategy to ameliorate the cardiometabolic consequences of obesity. Presentation: Thursday, June 15, 2023

Psychological symptoms in Multiple Sclerosis and the role of marital status: results from a retrospective single-center study

BackgroundMarried people have, on average, better mental health than no married people. Psychological symptoms as anxiety and depression occur frequently in patients with multiple sclerosis (MS), increasing the severity of neurologic disability. The aim of this retrospective study was to investigate the relationship between functional disability and psychological symptoms differentiating by marital status. MethodsIn this study 150 MS outpatients without a history of psychological disorders were selected from the hospital database. The outpatient procedure for all patients includes the administration of the Expanded Disability Status Scale and the questionnaire Symptoms Checklist-90-Revised (SCL-90-R) a multidimensional self-report inventory, consisting of 90 items covering nine clinical dimensions: somatization (SOM), obsessive-compulsive (OC), interpersonal sensitivity (IS), depression (DEP), anxiety (ANX), hostility (HOS), phobic anxiety (PHOB), paranoid ideation (PAR), psychoticism (PSY), and three global indices of distress: global severity index (GSI), positive symptoms total (PST) and positive symptom distress index (PSDI). According to marital status, subjects were subdivided in single, married (including cohabitants), and divorced (including separated). A nonparametric group comparisons analysis was performed, as well as multivariate analysis which included generalized linear regression models. ResultsRegression results showed that functional disability was a significant predictor for all SCL- 90-R subscales. Moreover, it would seem that the single condition might be a protective factor for the development of psychological symptoms in SM patients. Notably, findings showed that younger subjects were predominantly single and had less psychological symptoms, whereas patients with greater psychological alterations were older in a stable affective couple relationship, presenting an elevation in depression, anxiety, somatization and compulsive, and obsessive scales. ConclusionNumerous factors contribute to the onset of psychological disorders in multiple sclerosis. Marriage does not represent a protective factor for the development of psychological symptoms in SM patients. Future investigation is needed to ascertain the prevalence and underlying causes of psychological symptoms.

SAT474 A Case Report Of Moyamoya Disease Associated With Uncontrolled Graves' Disease

Abstract Disclosure: Z. Tan: None. E. Briggie: None. M. Correia: None. Background: Moyamoya disease is an uncommon cerebrovascular disease that is featured by narrowing of large intracranial arteries and the development of prominent small-vessel collaterals. The etiology of Moyamoya disease is unknown, but it can be associated with multiple conditions including atherosclerosis, sickle cell disease, and Protein S deficiency. It is rarely associated with uncontrolled Graves’ disease. Clinical Case: A 37-year-old female with a history of Graves’ disease and type 1 diabetes presented with sudden onset of slurred speech and right-sided weakness. A CTA of the head and neck showed a small hypodensity in the left basal ganglia without corresponding perfusion deficit and narrowed left internal carotid arteries without focal stenosis. In addition, a brain MRI showed patchy infarcts in the left middle cerebral artery territory. A cervical and cerebral angiogram showed multiple areas of stenosis which was concerning for Moyamoya disease. She ultimately underwent balloon angioplasty of the left internal carotid artery with improvement in perfusion. During the workup for secondary causes of Moyamoya disease, her TSH was &amp;lt; 0.01 µIU/mL (0.270-4.20 µIU/mL), with elevated T4 at 3.84 ng/dl (0.80-1.80 ng/dl) and elevated TSI at 15.5 IU/L (&amp;lt; 0.54 IU/L). Importantly, she was diagnosed with Graves’ disease 2 years before admission, and this condition has never been well controlled due to poor compliance with methimazole. A TSH measured 5 months before admission was also undetectable with elevated T4 at 2.8 ng/dl. Her other workups for Moyamoya disease were negative including HIV antigen/antibody, syphilis IgG antibody, Lyme disease IgG &amp; IgM antibodies, hepatitis panel antibodies, ANA, ANCA, free protein S, dsDNA antibody, factor 5 Leiden mutation, vascular endothelial growth factor-D and urine drug screening test. She started methimazole 20 mg daily and was discharged to acute rehabilitation. After rehabilitation, her Graves’ disease is slowly improving with most recent TSH &amp;lt; 0.008 µIU/mL and free T4 at 2.39 ng/dl. She is almost back to her baseline with significant improvement in speech and strength. Conclusion: Uncontrolled Graves’ disease should be considered in the differential diagnosis of Moyamoya disease in young subjects who present with stroke-like symptoms. Reference: Ischemic Stroke and Intraventricular Hemorrhage in Moyamoya Syndrome Associated With Graves' Disease: A Case Report. Neurologist 2022 Presentation Date: Saturday, June 17, 2023

Cardiovascular responses to combined mechanoreflex and metaboreflex activation in healthy adults: effects of sex and low- versus high-hormone phases in females.

Females generally have smaller blood pressure (BP) responses to isolated muscle mechanoreflex and metaboreflex activation compared with males, which may explain sex differences in BP responses to voluntary exercise. The mechanoreflex may be sensitized during exercise, but whether mechanoreflex-metaboreflex interactions differ by sex or variations in sex hormones remains unknown. Thirty-one young healthy subjects (females, n = 16) performed unilateral passive cycling (mechanoreflex), active cycling (40% peak Watts), postexercise circulatory occlusion (PECO; metaboreflex), and passive cycling combined with PECO (combined mechanoreflex and metaboreflex activation). Beat-to-beat BP, heart rate, inactive leg vascular conductance, and active leg muscle oxygenation were measured. Ten females underwent exploratory testing during low- and high-hormone phases of their self-reported menstrual cycle or oral contraceptive use. Systolic BP and heart rate responses did not differ between sexes during active cycling [Δ30 ± 9 vs. 29 ± 11 mmHg (males vs. females), P = 0.9; Δ33 ± 8 vs. 35 ± 6 beats/min, P = 0.4] or passive cycling with PECO (Δ26 ± 11 vs. 21 ± 10 mmHg, P = 0.3; Δ14 ± 7 vs. 18 ± 15 beats/min, P = 0.3). Passive cycling with PECO revealed additive, not synergistic, effects for systolic BP [males: Δ23 ± 14 vs. 26 ± 11 mmHg (sum of isolated passive cycling and PECO vs. combined activation); females: Δ26 ± 11 vs. 21 ± 12 mmHg, interaction P = 0.05]. Results were consistent in subset analyses with sex differences in active cycling BP (P > 0.1) and exploratory analyses of hormone phase (P > 0.4). Despite a lack of statistical equivalence, no differences in cardiovascular responses were found during combined mechanoreflex-metaboreflex activation between sexes or hormone levels. These results provide preliminary data regarding the involvement of muscle mechanoreflex-metaboreflex interactions in mediating sex differences in voluntary exercise BP responses.NEW & NOTEWORTHY The muscle mechanoreflex may be sensitized by metabolites during exercise. We show that cardiovascular responses to combined mechanoreflex (passive cycling) and metaboreflex (postexercise circulatory occlusion) activation are primarily additive and do not differ between males and females, or across variations in sex hormones in females. Our findings provide new insight into the contributions of muscle mechanoreflex-metaboreflex interactions as a cause for prior reports that females have smaller blood pressure responses to voluntary exercise.

Alterations in Lens Free Water Distribution Are Associated with Shape Deformation in Accommodation

To investigate whether a redistribution of water within the crystalline lens is associated with the shape deformation that occurs during accommodation. Observational, cross sectional study. Eleven young adults without presbyopia (aged 18-39 years) and 9 middle-aged adults with presbyopia (aged 40-55 years). Magnetic resonance imaging (MRI) scans of the lens were acquired on a 3 Tesla clinical MRI scanner, without and with the presentation of a 3 Diopter accommodative stimulus. The MRIs were postprocessed using established methods to extract the geometric dimensions and spatial maps of water distribution of the lens. Accommodative changes in the full 3-dimensional description of lens shape, the lens total-water distribution profile, and the lens free-water distribution profile. Viewing of an accommodative stimulus by young subjects elicited an elastic shape deformation of the lens consistent with accommodation that was associated with an elevated, smoother free-water distribution, primarily in the anterior region of the lens. In contrast, viewing of an accommodative stimulus by presbyopic subjects produced an atypical shape deformation of the lens that was instead associated with a lowered free-water distribution, primarily in the anterior region of the lens. No discernible changes to the lens total-water distribution were observed in response to the accommodative stimulus in either subject cohort. The present study suggests that protein-mediated alterations in the free-water distribution of the anterior region of the lens influence the shape deformation in accommodation, presenting pharmacological modulation of free-water distribution as an attractive novel approach for treating presbyopia. The authors have no proprietary or commercial interest in any materials discussed in this article.

Asymmetry of Characteristics of the Right-Left Hemodynamic Balance of Microcirculation in the Temporal Skin Areas of the Head in Young Male and Female Subjects.

The indices of asymmetry of microcirculation in the skin of the temporal areas of the head in young male and female subjects were studied. In 20 healthy volunteers (10 men and 10 women, age 18-19 years), synchronous measurements of the microcirculation of the skin of the symmetrical temporal areas of the head were carried out by laser Doppler flowmetry. The coefficients of asymmetry of regression relationships between perfusion changes in each side and initial perfusion values in both the same and opposite sides, the distribution function of perfusion asymmetry coefficients, and variability of perfusion in the studied areas were analyzed. The sex differences of the measured characteristics of asymmetry were revealed. In men, the distribution functions of perfusion asymmetry are pointed, with positive excesses, and in women they were flat, with negative excesses. In female subjects, the contribution of the right microcirculatory bed to the right-left hemodynamic balance was higher. These findings support the hypothesis on greater plasticity of the female brain in comparison with the male brain.

Effect of Subsensory Vibration on Postural Control of Healthy Elderly and Subjects with Simulated Reduced Plantar Feet Sensation: A Randomized Crossover Controlled Trial

Abstract Introduction Postural instability is considered a normal result of aging and is caused by some diseases such as neuropathy. Aim The purpose of the present study was to analyze and compare the effect of subthreshold vibration that was applied to the plantar surface of feet on balance control of healthy elderly and young subjects with simulated decreased plantar feet sensation. Methods Twenty-four subjects (12 elderly persons and 12 young persons with decreased plantar feet sensation) were included in this randomized, double-blinded crossover study. Participants were divided into two intervention groups: 1) orthopedic shoe with vibration mechanism on; and 2) orthopedic shoe with vibration off. Primary outcomes were center of pressure (COP) parameters including mean velocity, phase plane portrait, standard deviation (SD) of amplitude, and SD of velocity. Secondary outcomes were Berg Balance Scale (BBS) score and timed up and go test (TUG). The standing balance was tested with different conditions: eye opened/closed and foam/rigid surface. General linear mixed models tests were used for statistical analysis. The level of statistical significance was set at 0.05 for all analyses. Discussion This study showed very large effect sizes (partial η2 &gt; 0.2) with application of vibration as compared with vibration off for COP parameters with greater effects in condition with more baseline fluctuations. There was significant change in BBS test (Cohen d, 0.6; confidence interval [CI], −0.215 to −1.421). The time on TUG test was decreased and approached significance (P = 0.06). Conclusions The immediate effect of the study showed that subthreshold vibration can improve static and dynamic balance in healthy elderly people and people with decreased plantar feet sensation. However, long-term studies are needed to establish the clinical value of the subthreshold vibration on balance control. Clinical Relevance Subthreshold vibration applied to the feet soles via custom-made shoes can reduce the postural sway in subjects with decreased feet sensation. By conducting more studies with conclusive results in the field of vibration effectiveness in the elderly, we can hope to reduce the rate of falls in the elderly.

Test-retest reliability of isometric shoulder muscle strength during abduction and rotation tasks measured using the Biodex dynamometer.

The Constant score (CS) is often used clinically to assess shoulder function and includes a muscle strength assessment only for abduction. The aim of this study was to evaluate the test-retest reliability of isometric shoulder muscle strength during various positions of abduction and rotation with the Biodex dynamometer and to determine their correlation with the strength assessment of the CS. Ten young healthy subjects participated in this study. Isometric shoulder muscle strength was measured during 3 repetitions for abduction at 10° and 30° abduction in the scapular plane (with extended elbow and hand in neutral position) and for internal and external rotation (with the arm at 15° abduction in the scapular plane and elbow flexed at 90°). Muscle strength tests with the Biodex dynamometer were measured in 2 different sessions. The CS was acquired only in the first session. Intraclass correlation coefficients (ICCs) with 95% confidence interval, limits of agreement, and paired t tests for repeated tests of each abduction and rotation task were calculated. Pearson's correlation between the strength parameter of the CS and isometric muscle strength was investigated. Muscle strength did not differ between tests (P>.05) with good to very good reliabilities for abduction at 10° and 30°, external rotation and internal rotation (ICC >0.7 for all). A moderate correlation of the strength parameter of the CS with all isometric shoulder strength parameters was observed (r>0.5 for all). Shoulder muscle strength for abduction and rotation measured with the Biodex dynamometer are reproducible and correlate with the strength assessment of the CS. Therefore, these isometric muscle strength tests can be further employed to investigate the effect of different shoulder joint pathology on muscle strength. These measurements consider a more comprehensive functionality of the rotator cuff than the single strength evaluation in abduction within the CS as both abduction and rotation are assessed. Potentially, this would allow for a more precise differentiation between the various outcomes of rotator cuff tears.

Predictors of efficacy of Sodium-GLucose Transporter-2 inhibitors and Glucagon-Like Peptide 1 receptor agonists: Aretrospective cohort study.

The aim of the present study was to verify predictors of HbA1c reduction with Sodium-GLucose Transporter-2 (SGLT2) inhibitors and Glucagon-Like Peptide 1 (GLP1) receptor agonists in routine clinical practice. A retrospective cohort study was performed, enrolling patients with type 2 diabetes aged ≥18years who received a prescription of an SGLT2 inhibitor or a long-acting GLP1 receptor agonist with at least 6months of persistence in therapy. Therapeutic success was defined as HbA1c reduction >10mmol/mol or attainment of the recommended HbA1c target. Out of 236 patients receiving SGLT2 inhibitors, 148 were categorised as successes: successes had a mean lower age and higher estimated Glomerular Filtration Rate than failures, but only age retained statistical significance at multivariate analysis (Odds Ratio with 95% confidence interval: 0.94 [0.91-0.98], p=0.006). In the GLP1 receptor agonists cohort (N=214) there were 146 successes, showing a significantly shorter duration of diabetes even after adjusting for age, and baseline HbA1c (HR 0.96 [0.91-0.99], p=0.02). The present study is a preliminary exploration of factors associated with HbA1c response to SGLT2 inhibitors and GLP1 receptor agonists. Differences in predictors of HbA1c changes across different classes of drugs could be useful in identifying the most suitable drug in individual patients. SGLT2 inhibitors seem to be associated with a greater reduction of HbA1c in younger subjects, and GLP1 agonists in those with a shorter duration of diabetes.

A-060 Thyroid Laboratory Database Assessment Shows that Total Triiodothyronine Significantly Decreases with Age

Abstract Introduction The effects of aging on human thyroid function are well studied in relationship to thyroid stimulating hormone (TSH) and free tiroxine (FT4); TSH increases, while FT4 decreases with age. Although animal studies show that total triiodotironine (TT3) is lower in aged male rats, these changes are still not clear enough in humans. The National Academy of Clinical Biochemistry (NACB) suggests that TT3 levels would be lower in subjects over 60 years (y.), but the number of elderly assessed was too small for a robust statistical analysis. In search on PubMed, crosschecking the terms elderly/age/aging, with triiodothyronine/T3/total T3, there are a few studies available using current assays with a significant number of patients. Therefore, the demonstration of how the TT3 performs with age is still an opened question. Objective The aim of this study was to observe if TT3 changes significantly with age. Methods We, retrospectively, analyzed blood samples requesting serum TT3 of unique patients, who had TSH measured on the same day; and thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TGAb), anti TSH receptor antibodies (TRAb) or TSH receptor-stimulating immunoglobulin (TSI) at any time since patient admission. Subjects were adults ≥20 y., admitted to a private reference clinical laboratory in Brazil, from January 01, 2014 to December 31, 2022, using anonymized data. Serum TT3 was measured in Cobas Roche, by electrochemiluminescence assay, reference interval 70–210 ng/dL. Exclusion criteria were (and/or): tests performed in hospitals, use of drugs that could interfere on TT3 or TSH, TSH ≤ 0.1 mIU/L or ≥10.0 mIU/L, and any positive antibody at any time. The level of statistical significance was P &amp;lt; 0.05. Results Initially, 959 297 records from the database were surveyed. After applying the exclusion criteria, 141 819 subjects were eligible: mean age = 45 y.; median = 42 y., 62% female (F). Statistically significant differences - P &amp;lt; 0.05 for all comparisons between groups - were found by age and gender in TT3 mean values (in ng/dL). Regarding age: from 20 to 59 y. = 120 ± 26.6; 60 to 79 y. = 109 ± 20.7; and 80 y. and over = 97.2 ± 20.0. By gender: F = 120 ± 28.9; male = 114 ± 20.4. It was also observed that, in elderly, while TT3 decreases, TSH increases (results not shown). Comparing TT3 means by age groups, it is 9% lower in subjects aged 60–79 y. and 19% lower in those aged 80 y. and older, compared to younger (20–59 y.) subjects. Conclusion TT3 results is influenced by several factors, including age, gender and laboratory assay. As far as we know, searching in PubMed, this is the largest collection of data on the relationship between TT3 and age. The data obtained showed a statistically significant decrease in TT3 in elderly, and mainly in very elderly, and higher levels in women than in men. This finding draws call attention to the fact that these parameters should taken into account when evaluating TT3 levels.

Age-Related Changes in Sperm Morphology and Analysis of Multiple Sperm Defects.

Analysis of sperm morphology defects (amorphous heads, abnormal acrosome, etc.) is useful for estimating the efficiency of spermiogenesis and sperm maturation. An advanced paternal age (more than 40 years) is associated with decreasing sperm count and reduced motility; however, there is little information on the effect of aging relating to sperm morphological defects. Moreover, searching for stable combinations of certain morphological defects in the same sperm can be useful for better understanding spermiogenesis. The aim of the study was to investigate age-related changes in sperm morphology and the prevalence of certain combinations of sperm morphological defects in men from the general population. Sperm morphology was assessed in 1266 volunteers from the Russian urban general population in different age groups (18-19, 20-24, 25-29, 30-34, 35-40, and over 40 years old). Two hundred sperm were evaluated from each semen sample (about 250 thousand spermatozoa in total). Sperm defects were classified according to the WHO laboratory manual (WHO, 2010). The total percentage of each sperm defect and the frequency of different combinations of sperm morphological anomalies for each age group were counted. Additionally, a similar analysis was performed for the groups of normospermia and pathozoospermia. The frequency of coiled and short sperm tails increased in men over 40 years old compared to younger subjects; however, aging did not affect the percentage of morphologically normal sperm. It was shown that the combination of a misshaped head (amorphous, pyriform, and elongated) with a postacrosomal vacuole, acrosome defect, excess residual cytoplasm, or any anomaly of the midpiece or tail in the same spermatozoon were not random combinations of independent solitary defects. The increased frequency of combinations of coiled tails with amorphous, elongated, or vacuolated heads was observed in men older than 40 years. Sperm morphological defects, such as severely deformed heads (pyriform, elongated, and round) were more common in men with pathozoospermia compared to normospermic subjects. An age-related impairment in sperm morphology was found. Stable combinations of head defects with anomalies in the acrosome, midpiece or tail suggest that these defects may be the result of a general violation in the morphogenetic mechanism.

Julia M. Gossard. Young Subjects: Children, State-Building, and Social Reform in the Eighteenth-Century French World.

Julia M. Gossard. <i>Young Subjects: Children, State-Building, and Social Reform in the Eighteenth-Century French World</i>.

Immature event-related alpha dynamics in children compared with the young adults during inhibition shown by day-night stroop task.

Inhibitory control develops gradually from infancy to childhood and improves further during adolescence as the brain matures. Related previous studies showed the indispensable role of task-related alpha power during inhibition both in children and young adults. Nonetheless, none of the studies have been able to investigate the direct differences in brain responses between children and young adults when confronted with a stimulus that should be inhibited. Because, unlike event-related designs, task-related designs involve continuous tasks over a certain period, which precludes the possibility of making such a comparison. Accordingly, by employing event-related design, the present study first time in the literature, aimed to analyze the event-related alpha phase locking and event-related alpha synchronization/ desynchronization to differentiate the inhibitory processes in children compared to young adults. Twenty children between the ages of 6 to 7 years and 20 healthy young adult subjects between the ages of 18 to 30 years were included in the study. Day-night Stroop task was applied to all subjects during 18-channel EEG recordings. Event-related time-frequency analysis was performed with the complex Morlet Wavelet Transform for the alpha frequency band (8-13 Hz). Event related spectral perturbation (ERSP) in three different time windows (0-200 ms, 200-400 ms, 400-600 ms) and Event-related phase locking in the early time window (0-400 ms) was calculated. The children had increased alpha power in early and late time windows but decreased alpha phase locking in the early time windows compared to young adults. There were also topological differences between groups; while young adults had increased alpha phase-locking in frontal and parietal electrode sites, children had increased occipital alpha power and phase locking. The shift in event-related alpha power observed from posterior to anterior regions with age may suggest a progressive maturation of the frontal areas involved in inhibitory processes from childhood to adulthood. The results of the present study showed that children and young adults had different EEG oscillatory dynamics during inhibitory processes at alpha frequency range.

School Memories about Homophobic Bullying: A Study Based on Cultural-Historical Psychology.

The expression of homophobic violence in schools reveals the urgency of an analytical approach to debate the impact of this phenomenon on students' mental health. This article seeks to debate and better comprehend school memories from young gays, lesbians, and bisexuals, as well as to discuss how homophobic bullying affected their school trajectories. This study is based on cultural-historical psychology in intersection with gender and sexuality studies. In-depth online interviews were conducted with three young subjects who identified themselves as non-heterosexual. The interviews were recorded, transcribed, and analyzed through the analytical discourse tool defined as Nuclei of Meanings. The results were organized in two topics of discussion: (a) the problems associated with non-heterosexual identity in schools; (b) the search for other ways of experiencing sexual identity in school. Throughout the article, reflections were held about the challenges participants had to deal with in order to regularly attend school and be educated, as well as the obstacles they faced in building their own ways of recognizing their sexual identity. The unique ways in which these young subjects took a stand in the face of homophobic situations show new methods to create educational interventions in order to include sexual diversity and openness to different possibilities of being and acting.

Transient myocardial thickening: a retrospective analysis on etiological, clinical, laboratory, therapeutic, and outcome findings in 27 cats

Introduction/objectiveTransient myocardial thickening (TMT) in cats is a poorly characterized clinical entity. Therefore, this study aimed to provide descriptions of additional cats diagnosed with this clinical phenomenon. Animals, materials, and methodsFor this multicenter observational retrospective study, cats diagnosed with TMT were searched in three medical databases. TMT was defined for cats with at least two echocardiograms showing an increased end-diastolic left ventricular wall thickness (LVWTd; i.e. ≥6 mm) at presentation and subsequent echocardiographic normalization (i.e. LVWTd <5.5 mm). Signalment, history, clinical, laboratory, therapeutic, and outcome data were retrieved. ResultsTwenty seven cats were included. The median age was 3 years. In 9/27 cats, an antecedent event was documented. At admission, 27/27 cats had evidence of myocardial injury (median value of cardiac troponin I 5.5 ng/mL), 25/27 cats had congestive heart failure, 13/27 cats had hypothermia, 8/27 cats had systemic hypotension, 7/27 cats had bradycardia, and 7/27 cats had electrocardiographic evidence of an arrhythmia. The median LVWTd was 6.4 mm. A potential cause of myocardial injury was identified in 14/27 cats. The median time from diagnosis to a significant reduction in LVWTd was 43 days. DiscussionTMT can be diagnosed in a wide range of cats, including young subjects. An antecedent predisposing event and/or a possible causative trigger can be identified in some. The reduction in LVWTd that defines this phenomenon usually occurs over a variable time frame. ConclusionsThis study represents the largest investigation of TMT in cats and provides additional information on this uncommon clinical entity.