Roth and Rau (Germany)

BackgroundThis exploratory study investigates differences among patients enrolled in a clinical study based on referral type (self‐referred, doctor‐referred, or other), considering demographics, family history of Alzheimer's disease (AD) and other causes of symptoms, life circumstances, and clinical care factors.MethodPatients (n =608) were classified into three referral groups: self‐referred, doctor‐referred, and other. Data on demographics, family history of AD and other causes of symptoms, life circumstances, and clinical care factors were available. Descriptive analysis compared baseline characteristics across groups using Fisher’s exact test to derive p ‐values. Multivariable logistic regression analysis identified factors associated with referral type (self‐ and doctor‐referred).ResultResults indicate notable variations in patient characteristics and clinical factors between referral groups. In the group comparisons, there were no significant differences in age, gender, race, and number of previous visits between doctor‐referred and self‐referred patients. Self‐referred patients generally had higher socioeconomic status compared to doctor‐referred patients. Significant differences were observed in referral duration, with shorter referral durations for doctor‐referred patients compared to self‐referred patients (p <0.0005). Additionally, the type of doctors previously seen by the patient significantly differed between the two groups (p <0.0005). A higher number of self‐referred patients presented in primary care first than directly to specialists. 59% of patients (n =359) indicated a family history of AD and/or dementia. Logistic regression showed that this did not have a significant impact on the referral type. The three factors that did have a significant impact on the referral type were socioeconomic status, level of education and type of doctor seen previously (p <0.05).ConclusionUnderstanding differences in patient characteristics based on referral types can provide insights into removing barriers to diagnosis and improving equitable diagnostic access. Current results explore the role of the patient's social environment, such as level of education, and how it can influence actionability on self‐presentation to medical care. Furthermore, doctor referred patients seem to have more access to the healthcare system, with shorter times between doctor visits. Future studies should focus on potential solutions for implementation of measures that improve access to timely and accurate diagnosis.

Background: A decreased level of adiponectin is known as a predictor of adverse left ventricular remodeling and major adverse cardiac events (MACEs). We evaluated long-term MACEs following ST-segment elevation myocardial infarction (STEMI) in relation to adiponectin levels. Methods: This prospective study included a total of 73 consecutive STEMI patients. Adiponectin, CK, CK-MB, cTnI, CRP, HDL cholesterol, LDL cholesterol, triglycerides, and other routine laboratory parameters were considered, and myocardial revascularization and two-dimensional echocardiography were performed. Subjects were divided into two groups according to their serum adiponectin concentrations. Results: In total, 24 (32.87%) patients suffered from MACEs, 19 (26.02%) with adiponectin value ≤ 1.8 ng/mL (group 1) and 5 (6.84%) with adiponectin value > 1.8 ng/mL (group 2) (p < 0.013). Heart failure (Killip >1) was present in 14 cases (19.17%) in group 1 and in 3 cases (4.1%) in group 2 (p < 0.001). Kaplan–Meier analysis was used to depict the occurrence of MACEs according to the adiponectin threshold identified during hospitalization (1.8 ng/mL). The log-rank test revealed a statistically significant difference in survival between groups (p = 0.013), and the AUC value for adiponectin was 0.77 (95% CI, 0.66–0.89), p = 0.01. Based on univariate logistic regression analysis, adiponectin and BMI were significantly associated with MACEs (p = 0.018, p = 0.034). Multivariate logistic regression analysis shows that serum adiponectin predicts MACEs after STEMI (p = 0.011). Conclusions: We found significant associations between adiponectin levels and MACEs in patients who survived STEMI. The established cut-off value of 1.8 ng/mL for adiponectin during hospitalization identified patients at risk for MACEs.

Abstract Aberrant colours are commonly observed in many mammalian species, including dormice. The only way to accurately estimate the frequency of an unusual colouration is to use large datasets. In Germany, a citizen science project asked volunteers to report observations of garden dormice ( Eliomys quercinus ) using an online tool. The project received a total of 5,448 photographs and videos of living and 1,281 of dead garden dormice, which were verified by experts. Only one aberrantly coloured garden dormouse was documented in this dataset. This young individual was a true albino, it was killed by a domestic cat. No leucistic or melanistic individuals were observed among the 6,729 garden dormice. Colour anomalies in European dormouse species are a rare phenomenon and melanistic individuals have been most commonly documented. In edible dormice ( Glis glis ), only 0.5% of specimens are affected. With only 0.01%, aberrantly coloured garden dormice appear to be extremely rare in Germany. This could be related to higher predation rates of the more conspicuous light-coloured animals. During additional long-term observations at two sites, ten juvenile garden dormice were observed with pale fur, lacking the typical black face mask when first seen. Five of them were seen frequently over a period of 3 to 4 weeks. During this time, the normal colouration gradually appeared, indicating that the aberrant coat colour may only be temporary.

This paper examines the topic of digital twins from the perspective of grid operators and attempts to broaden the scope of this topic. Historically, many grid operators are organized in a very siloed manner and there are different opinions and perspectives on this. However in this paper we identify that system engineering will be essential for the development of the digital twin, thus we have to rethink our approach completely and adapt and change our current methods and processes. This will also provide us with significant support in the areas of sector coupling and sector integration.

Low body mass index (BMI) has been associated with marked low-density-lipoprotein-cholesterol (LDL-C) elevations in response to very-low-carbohydrate diets (VLCD). We report a case (51-year-old woman, BMI 18.5 kg/m2) whose LDL-C was >500 mg/dL on a VLCD. We characterized her plasma lipoproteins and noncholesterol-sterols (gas chromatography/mass spectrometry) and the DNA sequences of her genes affecting lipid metabolism. We also carried out a large population analysis (224,126 subjects, 54% female, mean age 54 years) examining interrelationships between BMI and serum lathosterol/total cholesterol and β-sitosterol/total cholesterol ratios. In this case, her LDL-C concentration increased from 142 mg/dL to 555 mg/dL on a VLCD, and her plasma β-sitosterol level was very high at 12.8 mg/L. DNA analysis revealed a heterozygous pathogenic ABCG5 exon 9 variant (c.1323_1324+2del at position g.44051049 TACAC>T). With dietary cholesterol restriction and ezetimibe therapy, her LDL-C and β-sitosterol levels decreased by 75% and 46% to 139 mg/dL and 7.1 mg/L, respectively. In the population analysis, we noted a significant inverse correlation between BMI and the plasma β-sitosterol/total cholesterol ratio (r = -0.573, P < .00001). Those with a BMI <20 kg/m2 had mean β-sitosterol/total cholesterol values that were significantly higher (+63%, P < .00001) than values in obese women. The converse was true for the plasma lathosterol/total cholesterol ratio. Similar findings were noted in men. Our data are consistent with the concepts that low BMI predisposes to increased plasma β-sitosterol/total cholesterol ratios and an increased serum LDL-C when on high cholesterol VLCD, and that this response may be markedly enhanced in subjects with pathogenic heterozygous ABCG5 variants.

Abstract Background Increased level of Apelin-12 is associated with decreased number of STEMI patients followed with no-reflow phenomenon after the percutaneous coronary intervention (PCI). Purpose We evaluated the influence of Apelin-12 on the no-reflow phenomenon in patients with ST-segment elevation myocardial infarction (STEMI). Methods In this study we included one hundred consecutive patients with STEMI of onset &amp;lt;12 hours, who underwent percutaneous coronary intervention (PCI). The levels of apelin-12, creatine kinase (CK), the MB fraction of creatine kinase (CK-MB), troponin I, CRP, and other routine laboratory parameters were measured. Measurement of Apelin-12 was done on the day of admission by were measured with enzyme-linked immunosorbent assay (ELISA) method. Thereafter patients were divided in two groups according to the TIMI flow grade. Results From a total of 100 STEMI patients who underwent pPCI, the median value of Apelin-12 of the patients with TIMI grade flow 3 (successful reperfusion) was 3.90 (0.45-15.25) and of the patients with no-reflow phenomenon (unsuccessful reperfusion, TIMI flow grade ≤2) was 1.80 (0.46-9.2), p &amp;lt; 0.001. Receiver operating characteristics (ROC) curve of Apelin-12 plots the true positive rate against the false positive rate at different cut-off points, AUC=0.71 (95% CI, 0.64-0.81), the cut off value for the Apelin-12 was 3.85ng/mL, p=0.001. Conclusions Increased level of Apelin-12 may be associated with decreased number of STEMI patients followed with no-reflow phenomenon after the percutaneous coronary intervention (PCI). The cut-off value for Apelin-12 may be used to identify patients at risk for reperfusion injury. Fig.1. ROC curve and Apelin-12 Table 1 and 2

The use of the anti-Müllerian hormone (AMH) serum concentration as a fertility marker has been shown in cows, sheep and mares and has been indicated in one study in female dogs. The aim of this study was to investigate the connection between the AMH serum concentration, taken at two defined time points during the bitch`s heat, and the litter size to investigate whether AMH can be used as a practical measurement for the individual breeding bitch to predict litter size. The study was carried out on 27 healthy female dogs presented for pre-breeding examination, considering all previously known influencing factors on AMH in the bitch such as age, body weight and estrous cycle phase at the time the sample was taken. Due to the AMH increase in early proestrus and its drop around ovulation, AMH was measured in blood samples taken within the first three days of heat (AMH1) and near ovulation (AMH2) with AMH1 being significantly higher than AMH 2 (p<0.001). There was a highly significant negative correlation of body weight and AMH at both sampling times (p<0.001). There were no significant results when the dogs were paired and grouped according to high or low AMH concentrations, but a significant effect of AMH serum concentration on litter size was found in the multifactorial analysis when the dogs were matched according to their body weight (AMH1: p=0.022; AMH2: p=0.030). In conclusion, a significant effect of the AMH concentration and the litter size among female dogs with matching body weight could be found, but a much larger sample collection is needed to evaluate reference intervals for AMH for bitches of different weight to predict the fertility of an individual bitch in the future.