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Urinary Incontinence in a Community-Based Autopsy Cohort Is Associated with Limbic Predominant Age-Related TDP-43 Encephalopathy Neuropathologic Changes

J Alzheimers Dis. 2023 May 20. doi: 10.3233/JAD-230425. Online ahead of print.


BACKGROUND: Dementia and urinary incontinence (UI) are etiologically complex clinical syndromes. Dementia and UI often occur in the same individuals, but underlying factors connecting them are incompletely understood.

OBJECTIVE: Query data from a community-based autopsy series to assess pathologies that underlie UI.

METHODS: Included research subjects came to autopsy from the University of Kentucky Alzheimer’s Disease Research Center longitudinal cohort. A total of 368 research volunteers met inclusion criteria for this cross-sectional study. The average age at death was 85.3 years and the average number of annual clinic visits was 5.2 visits. Statistical models were run to evaluate which pathologies were associated with UI. Data included pathologies scored according to conventional stage-based systems, and these studies were complemented by quantitative digital neuropathology.

RESULTS: Dementia was diagnosed at the final clinical visit in 208 (56.7% of the sample) and UI was documented in 156 (42.7%). UI was associated with depression and dementia (both p < 0.001). More women than men had a history of UI (p < 0.04), and women with UI had had more biological children than those without UI (p < 0.005). Participants with limbic predominant age-related TDP-43 encephalopathy neuropathologic changes (LATE-NC) were more likely to have UI than those without LATE-NC (p < 0.001). The presence of LATE-NC (Stage > 1) was associated with UI with or without severe Alzheimer’s disease neuropathologic changes and/or Lewy body pathology.

CONCLUSION: In this community-based autopsy cohort, multiple factors were associated with UI, but the neuropathologic change most robustly associated with UI was LATE-NC.

PMID:37248909 | DOI:10.3233/JAD-230425

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Chiral Amino Acid Profiling in Serum Reveals Potential Biomarkers for Alzheimer’s Disease

J Alzheimers Dis. 2023 May 20. doi: 10.3233/JAD-230142. Online ahead of print.


BACKGROUND: Alzheimer’s disease (AD) is a complex neurodegenerative disease, and increasing evidence has linked dysregulation of amino acids to AD pathogenesis. However, the existing studies often ignore the chirality of amino acids, and some results are inconsistent and controversial. The changes of amino acid profiles in AD from the perspective of enantiomers remain elusive.

OBJECTIVE: The purpose of this study is to investigate whether the levels of amino acids, especially D-amino acids, are deregulated in the peripheral serum of AD patients, with the ultimate goal of discovering novel biomarkers for AD.

METHODS: The chiral amino acid profiles were determined by HPLC-MS/MS with a pre-column derivatization method. Experimental data obtained from 37 AD patients and 34 healthy controls (HC) were statistically analyzed.

RESULTS: Among the 35 amino acids detected, D-proline, D/total-proline ratio, D-aspartate, and D/total-aspartate ratio were decreased, while D-phenylalanine was elevated in AD compared to HC. Significant age-dependent increases in D-proline, D/total-proline ratio, and D-phenylalanine were observed in HC, but not in AD. Receiver operator characteristic analyses of the combination of D-proline, D-aspartate, D-phenylalanine, and age for discriminating AD from HC provided satisfactory area under the curve (0.87), specificity (97.0%), and sensitivity (83.8%). Furthermore, the D-aspartate level was significantly decreased with the progression of AD, as assessed by the Clinical Dementia Rating Scale and Mini-Mental State Examination.

CONCLUSION: The panels of D-proline, D-phenylalanine, and D-aspartate in peripheral serum may serve as novel biomarker candidates for AD. The latter parameter is further associated with the severity of AD.

PMID:37248903 | DOI:10.3233/JAD-230142

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The association between marathon running and high-sensitivity cardiac troponin: A systematic review and meta-analysis

J Back Musculoskelet Rehabil. 2023 May 18. doi: 10.3233/BMR-220352. Online ahead of print.


BACKGROUND: Marathon running is an extreme sport with a distance of about 42 kilometers. Its relationship to high-sensitivity cardiac troponin (hs-cTn) remains controversial.

OBJECTIVE: As the gold standard for detecting myocardial injury, the trends of hs-cTn before and after a marathon were investigated and analyzed.

METHODS: A literature search was conducted in PubMed, EMBASE, and Cochrane Library databases by combing the keywords marathon and troponin, and studies regarding high-sensitivity cardiac troponin I (hs-cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) concentrations before and after marathon running (not for half-marathon and ultra-marathon) were included. “Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group” were used to assess the risk of bias. Statistical analysis was performed using Review Manager, presenting data as mean values and 95% confidence intervals (CIs). Sensitivity analysis and subgroup analysis were performed if there was high heterogeneity among studies based on I2 statistic.

RESULTS: A total of 13 studies involving 824 marathoners were included in this systematic review and meta-analysis. Both hs-cTnI (MD 68.79 ng/L, [95% CI 53.22, 84.37], p< 0.001) and hs-cTnT (MD 42.91 ng/L, [95% CI 30.39, 55.43], p< 0.001) were elevated after running a marathon, but the concentration of hs-cTnT returned to baseline after 72 to 96 h post-race (MD 0.11 ng/L, [95% CI -1.30, 1.52], p= 0.88). The results of subgroup analysis demonstrated that the 99th percentile upper reference limit of hs-cTnT might be the source of heterogeneity.

CONCLUSION: The concentrations of hs-cTnI and hs-cTnT were increased after marathon running, but the change of hs-cTnT is usually not seen as irreversible myocardial injury.

PMID:37248881 | DOI:10.3233/BMR-220352

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Isokinetic strength assessment of trunk muscle and its relationship with spinal-pelvic parameters in patients with degenerative spinal deformity

J Back Musculoskelet Rehabil. 2023 May 18. doi: 10.3233/BMR-220288. Online ahead of print.


BACKGROUND: The incidence rate of degenerative spinal deformity (DSD) has gradually increased in the elderly. Currently, the relationship between the functional status of trunk muscle and the spinal-pelvic parameters of DSD patients remains unclear.

OBJECTIVE: This paper aims to explore the relationship between the two factors and provide new clues for exploring the mechanism of the occurrence and development of DSD.

METHODS: A total of 41 DSD patients treated in our hospital (DSD group) and 35 healthy volunteers (control group) were selected. Muscle strength was evaluated using an IsoMed-2000 isokinetic dynamometer, and the trunk flexor and extensor peak torque (PT) of subjects was measured at a low, medium, and high angular velocity of 30∘/s, 60∘/s, and 120∘/s, respectively. Hand grip strength (HGS) was assessed using an electronic grip dynamometer and Surgimap software was used to measure the spinal-pelvic parameters, including the sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence rate (PI), and PI-LL, and the relationship between trunk muscle function and various parameters was analyzed.

RESULTS: Under the three angular velocities, the flexor and extensor PT values in the DSD group were lower than those in the control group, and only the extensor PT showed a statistically significant difference (P< 0.05). There was no significant difference in HGS between the two groups (P> 0.05). In the DSD group, the extensor PT at 30∘/s was significantly negatively correlated with SVA (P< 0.05). At 60∘/s and 120∘/s, the extensor PT was significantly negatively correlated with SVA and PT (P< 0.05).

CONCLUSION: Trunk extensor strength is significantly lower in DSD patients than in normal controls. The decline in trunk extensor strength in DSD patients is a type of local muscle dysfunction more closely related to the deformity, which is likely involved in the compensatory mechanism of DSD and may reflect the overall imbalance of the trunk.

PMID:37248878 | DOI:10.3233/BMR-220288

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Evaluation of clinical oral care outcomes according to nursing outcomes classification

Int J Nurs Knowl. 2023 May 30. doi: 10.1111/2047-3095.12427. Online ahead of print.


PURPOSE: This research was planned to follow the healing process of the oral mucosa in patients in intensive care with an “Impaired Oral Mucous Membrane Integrity” nursing diagnosis based on the “NOC (1100) Oral Health Assessment” outcome criteria.

METHOD: This study, which was planned in a methodological and descriptive type of research, was carried out with 50 patients who were hospitalized in the intensive care clinic of a state hospital between June and December 2022, with a nursing diagnosis of “Impaired Oral Mucous Membrane Integrity.” Data were collected using a Patient Information Form and the “NOC (1100) Oral Health Evaluation Scale” for the nursing outcomes classification. In the analysis of the data descriptive statistical methods, Pearson correlation test, Friedman test as well as Cohen’s kappa test were used to evaluate the agreement between two independent observers.

FINDINGS: In the study, content validity index value of the NOC scale was calculated to be 0.90. The examination of the participants’ mean scores on the NOC (1100) Oral Health Assessment Scale showed that there were statistically significant differences in terms of the repeated evaluations, except for the NOC indicators of “Oral mucosal integrity,” “Gum integrity,” and “Tooth integrity” (p < 0.01). No statistically significant correlation was found between the mean NOC scale scores of the patients according to the variables of age, body mass index, mechanical ventilation time, and length of stay in the intensive care unit (p > 0.05).

CONCLUSIONS: The findings showed that the Turkish version of NOC (1100) Oral Health Assessment Scale was a valid tool for monitoring the healing process of the oral mucosa in patients in intensive care.

IMPLICATIONS OF NURSING PRACTICE: With the use of NOC (1100) Oral Health Assessment Scale, a common language will be formed in the evaluation for monitoring the healing process of the oral mucosa in nursing care.

PMID:37248868 | DOI:10.1111/2047-3095.12427

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Premature depolarisations in horses competing in United States Eventing Association and Fédération Equestre Internationale-sanctioned 3-day events

Equine Vet J. 2023 May 30. doi: 10.1111/evj.13948. Online ahead of print.


BACKGROUND: Injuries and sudden death during the cross-country (XC) phase of eventing have raised interest in the frequency and types of cardiac arrhythmias occurring in these equine athletes.

OBJECTIVES: To characterise the frequency and types of rhythm disturbances and examine possible risk factors for premature depolarisations (PDs) occurring during the XC phase of United States Eventing Association (USEA) and Fédération Equestre Internationale (FEI)-sanctioned events.

STUDY DESIGN: Prospective, cross-sectional study.

METHODS: Continuous electrocardiographic (ECG) recordings were obtained from horses prior to, during and immediately following the XC competition. Physiological rhythms pre-XC were included in the arrhythmia group for analysis. The frequency of PDs was calculated for all horses, as well as by division. PDs were categorised by complexity (singles, couplets, triplets, complex) and variably grouped for statistical analysis. Multiple logistic regression was used to identify risk factors for the presence of specific cardiac arrhythmia groupings during XC.

RESULTS: PDs were identified in 42/75 horses (56% [45, 67]) during XC. Horses competing in the upper divisions of eventing had higher odds for having any PD during XC compared to the lower divisions (OR = 17.5 [4.3, 72.01], p = 0.006). The amount of time the heart rate (HR) was greater than 199 beats per minute (BPM) was associated with more complex arrhythmias (triplets, salvos and tachyarrhythmias) (OR = 1.01 [1.0, 1.02], p = 0.005). An arrhythmia at rest (physiological or PD) was associated with arrhythmia in the early recovery period (OR = 3.5 [1.1, 10.8], p = 0.03).

MAIN LIMITATIONS: Convenience sampling and technical challenges of continuous ECG recordings under competition settings limited the number of enrollments.

CONCLUSIONS: PDs were seen in a high percentage of horses during the XC competition. Upper levels and time the HR was greater than 199 BPM were related to PD presence and complexity.

PMID:37248851 | DOI:10.1111/evj.13948

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Distribution of monocyte subsets and their surface CD31 intensity are associated with disease course and severity of hemorrhagic fever with renal syndrome

Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi. 2023 May;39(5):439-444.


Objective To investigate the relationship between disease courses and severity and monocyte subsets distribution and surface CD31 intensity in patients of hemorrhagic fever with renal syndrome (HFRS). Methods Peripheral blood samples from 29 HFRS patients and 13 normal controls were collected. The dynamic changes of classical monocyte subsets (CD14++CD16), intermediated monocyte subsets (CD14++CD16+) and non-classical monocyte subsets (CD14+CD16++) and the mean fluorescent intensity (MFI) of CD31 on monocyte subsets were detected by multiple-immunofluorescent staining and flow cytometry. Results In acute phase of HFRS, the ratio of classical monocyte subsets to total monocytes was dramatically decreased compared to convalescent phase and normal control. It was still much lower in convalescent phase compared to normal controls. The ratio of classical monocyte subsets to total monocytes were decreased in HFRS patients compared to that in normal control, whereas there was no difference between severe/critical groups and mild/moderate groups. On the contrary, the ratio of intermediate monocyte subsets to total monocytes in acute phase of HFRS was significantly increased compared to convalescent phase and normal control. The ratio of intermediate monocyte subsets to total monocytes were increased in HFRS patients compared to that in normal control, whereas no difference was found between severe/critical groups and mild/moderate groups. Phases or severity groups had no difference in ratio of non-classical monocyte subsets to total monocytes. Additionally, the ratio of classical monocyte subsets had a tendency to decline and that of intermediate monocyte subsets showed an increase both to total monocytes between the acute and convalescent phases in 11 HFRS patients with paired-samples. Moreover, in acute phase of HFRS, the mean fluorescent intensity (MFI) of CD31 on three monocyte subsets all decreased, specifically classical monocyte subsets showed the highest MFI of CD31 while the normal control reported the highest MFI of CD31 in non-classical monocyte subsets. In convalescent phase, the MFI of CD31 on classical and intermediated monocyte subsets were both lower than that of normal control, while MFI of CD31 was still significantly lower than normal control on non-classical monocyte subsets. Finally, MFI of CD31 on classical and intermediated monocyte subsets in severe/critical group were both lower than those in mild/moderate group, showing no statistical difference in MFI of CD31 on non-classical monocyte subset across groups of different disease severity. Conclusion The ratio of classical and intermediated monocyte subsets to total monocytes are correlated with the course of HFRS, and so are the surface intensity of CD31 on these monocyte subsets with the disease course and severity. The surface intensity of CD31 on non-classical monocyte subsets, however, is correlated only with the course of the disease. Together, the underlying mechanisms for the observed changes in monocyte subsets in HFRS patients should be further investigated.


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Pharmacogenetics of pain management in Zimbabwean patients with sickle cell disease

Pharmacogenomics. 2023 May 30. doi: 10.2217/pgs-2023-0045. Online ahead of print.


Background: Pain is a common cause of hospitalization in sickle cell disease (SCD) patients. Failure to effectively control pain remains a challenge in patient care. Materials & methods: The authors conducted a cross-sectional study to determine the effect of CYP2D6 and UGT2B7 polymorphisms on pain management in 106 Zimbabwean SCD patients. Participant information was collected on a questionnaire. Genotyping was conducted using the GenoPharm® pharmacogenomics open array panel containing CYP2D6 and UGT genetic variants implicated in opioid response. Results: The reduced function alleles CYP2D6*17 and *29 had high frequencies of 15.9% and 12.9%, respectively. UGT2B7 rs73823859 showed a statistically significant correlation with pain levels (p = 0.0454). Conclusion: This study demonstrated the role of UGT2B7 polymorphism in SCD patient pain management.

PMID:37248824 | DOI:10.2217/pgs-2023-0045

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The self-perceived competency of dental students about contagious diseases during the COVID-19 pandemic and its effect on their career plans

Adv Clin Exp Med. 2023 May 30. doi: 10.17219/acem/166045. Online ahead of print.


BACKGROUND: Dentistry is reported as a very-high-risk profession for COVID-19 contagion. A lack of face-to-face education and poor information during the COVID-19 pandemic may have impacted dental students.

OBJECTIVES: We aimed to evaluate the effects of the COVID-19 pandemic on career plans and self-perception of knowledge levels in undergraduate dental students.

MATERIAL AND METHODS: In this multicenter cross-sectional study, a multiple-choice survey was completed by dental students of Near East University (NEU) in North Nicosia and University of Kyrenia (UoK) in the Turkish Republic of Northern Cyprus (TRNC), and Erciyes University (ERU) in Kayseri, Turkey, in 2020. The χ2 tests were used to determine statistically significant differences.

RESULTS: Of the 755 students that participated in the study, 66% declared fear of being at risk for contagion. More than half of the students reported not having sufficient knowledge about occupational infections and methods for protection, and the percentages were significantly higher in female and preclinical students. Utilization of credible publications, guidelines (57% compared to 34%, p < 0.001) and online education (19% compared to 8%, p < 0.001) were significantly higher in students claiming to have adequate knowledge. Eleven percent of the students thought about dropping out of dental education because of the COVID-19 pandemic. These students exhibited a markedly increased fear of being at risk for contagion because of the COVID-19 pandemic (80% compared to 64%, p = 0.011). Seventy-six percent of the students were aiming for a dental specialty. Eighteen percent changed their desired specialty, and 25% were in search of a specialty that they believed required fewer close contact procedures.

CONCLUSIONS: It is crucial to prepare students for the next possible outbreak using the knowledge gained during this pandemic by modifying the dental curriculum and providing credible information and psychological support to guide dental students in building a healthy career path.

PMID:37248822 | DOI:10.17219/acem/166045

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Evaluation of a platform-switched Morse taper connection for all-on-four or six treatment in edentulous or terminal dentition treatment: A retrospective study with 1-8 years of follow-up

Clin Implant Dent Relat Res. 2023 May 29. doi: 10.1111/cid.13228. Online ahead of print.


BACKGROUND: The survival rate, marginal bone loss and soft tissue health of the Ankylos implants and the balanced base abutments in all-on-four or six implant restoration of edentulous or terminal dentition patients has not been reported in the clinical research.

PURPOSE: This retrospective study aimed to evaluate the Ankylos implants and the balanced base abutments in all-on-four or six implant restoration of edentulous or terminal dentition patients after 1-8 years of follow-up.

MATERIALS AND METHODS: A retrospective study was conducted based on the medical records of 33 patients who received all-on-four or six treatments from April 2014 to May 2020. Four radiographic examinations [immediate postoperative (T0), definitive restorations (T1), 1-3 years after prosthetic restorations (T2), and more than 3 years after prosthetic restorations (T3)] were obtained to evaluate vertical bone height (VBH). We also calculated the survival rate and examined the condition of soft tissue with this implant system in edentulous or terminal dentition patients. Three-level linear model analyses were used to explore potential risk factors for VBH changes on the mesial and distal sides. The generalized linear model was used to analyze the influencing factors of BOP and plaque.

RESULTS: A total of 218 implants were included in this study. The cumulative survival rate of the implants was 97.25% before the definitive prosthesis, 96.33% within 3 years of follow-up and 95.32% after more than 3 years of follow-up. The mean ± standard deviation (SD) bone losses of the VBH were 0.27 ± 0.05 mm (T1-T3) on the mesial side and 0.49 ± 0.06 mm (T1-T3) on the distal side. During 1-8 years of follow-up, the height and angle of the abutment (p < 0.001), the mandible implant site (p < 0.001), the length of the implant (p = 0.014 < 0.05) and age (p = 0.029 < 0.05) showed statistically significant effects on vertical mesial bone height (VMBH) and vertical distal bone height (VDBH). The risk of BOP among participants who brushed three times a day was lower than those who brushed less than three times. The plaque risk of short abutment height was higher than the long abutment.

CONCLUSION: The current study showed that the Ankylos implants with the balanced base abutments in all-on-four or six implants treatment is a viable and predictable option with a high survival rate and low marginal bone loss in edentulous or terminal dentition patients. VBH around the implants was strongly associated with the mandible implant site, abutment height and angle, the length of the implant and age. Moreover, teeth-brushing times and abutment height significantly affect soft tissue health.

PMID:37248812 | DOI:10.1111/cid.13228