强直性脊柱炎患者血清MMP-9、DKK-1水平与疾病活动度的关系

目的探讨强直性脊柱炎(AS)患者血清基质金属蛋白酶-9(MMP-9)、Dickopff相关蛋白-1(DKK-1)水平与疾病活动度的关系。方法将该院风湿免疫科接诊的145例AS患者纳入AS组,并根据疾病活动指数(BASDAI)评分,分为非活动期组(4分)48例、活动期组(≥4分)97例,给予肿瘤坏死因子-α(TNF-α)拮抗剂治疗24周;另选取年龄、性别相匹配的健康体检者62例为对照组;测定血沉(ESR)、C反应蛋白(CRP)、MMP-9、DKK-1水平和疾病活动度[BASDAI、AS功能指数(BASFI)、AS病情活动度评分(ASDAS)],并分析DKK-1、MMP-9与BASDAI、BASFI、ASDAS评分的关系。结果 AS组ESR和血清CRP、MMP-9水平均高于对照组(P0.05),血清DKK-1水平低于对照组(P0.05);活动期组血清DKK-1低于非活动期组(P0.05),血清MMP-9水平高于非活动期组(P0.05);AS患者治疗后血清DKK-1、AS脊柱评分(mSASSS)评分均无明显变化(P0.05),MMP-9和BASDAI、BASFI、ASDAS评分均明显下降(P0.05);相关性分析显示,DKK-1与BASDAI、BASFI、ASDAS评分无明显相关性(P0.05);MMP-9与BASFI评分不相关(P0.05),与BASDAI、ASDAS评分呈正相关(P0.05)。结论 AS患者血清DKK-1呈低表达,MMP-9呈高表达,TNF-α拮抗剂能明显下调MMP-9水平,对DKK-1无明显影响,MMP-9可反映AS的疾病活动度,DKK-1与疾病活动度无明显相关。     

重症肌无力患儿血清 YKL-40水平变化及临床意义

目的　观察重症肌无力（myasthenia gravis, MG）患儿血清 YKL-40水平变化情况,探讨其临床意义。方法　收集 2017年 1月 ~2020年 10月在西安医学院第一附属医院治疗的 42例 MG患儿及 50例对照组儿童血液样本。采用 ELISA法检测比较各组血清 YKL-40水平,分析血清 YKL-40水平与定量重症肌无力（ QMG）评分的相关性,探讨 MG患儿血清 YKL-40水平对病情严重程度的评估价值。结果　MG患儿血清 YKL-40水平显著高于对照组（ 83.35±15.26 ng/ml vs 47.75±7.45 ng/ml）,差异有统计学意义（ Z=7.823,P＜ 0.001）,全身型（Ⅱ a型 + Ⅱ b型）患儿血清 YKL-40水平高于眼肌型（Ⅰ型）患儿,差异有统计学意义（ t=2.214,P＜ 0.05）,急性期患儿血清 YKL-40水平明显高于缓解期患儿（ 83.35±17.05ng/ml vs 78.98±17.63ng/ml）,差异有统计学意义（ t=7.324,P＜ 0.001）。MG患儿血清 YKL-40水平与 QMG评分呈正相关关系（ r=0.616,P＜ 0.001）。多元线性回归分析结果显示血清 YKL-40水平是 MG患儿 QMG评分的独立影响因素（ Beta=0.659,P＜ 0.001）。ROC曲线分析结果显示血清 YKL-40预测高四分位 QMG评分的曲线下面积为 0.828（0.703,0.953）。结论　MG患儿血清 YKL-40水平升高,可能与 MG急性起病及病情严重程度相关。     

重症患者血清PCT，sTREM-1和YKL-40水平与呼吸机相关性肺炎发生的相关性研究

目的　探讨血清可溶性髓系细胞触发受体(soluble triggering receptor expressed on myeloid -1,sTREM-1)、降钙素原（procalcitonin,PCT）和人软骨糖蛋白39 ( human cartilage glycoprotein-39,YKL-40)对呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)患者的表达意义、VAP预后的预测价值及VAP发生的危险因素。方法　选取2018年1月~2020年6月在河北省邢台市第三医院ICU进行呼吸机通气并发生VAP的120例患者为VAP组,纳入同期未发生VAP的120例患者为非VAP组,收集两组一般资料和进入ICU 1,3,5和7天的血清PCT,sTREM-1和YKL-40水平,Logistic回归分析VAP发生的危险因素。将120例VAP患者根据28天的生存情况分为生存组（74例）和死亡组（36例）,测定两组患者的PCT,sTREM-1和YKL-40水平,采用ROC曲线图判定其预测价值。结果　①VAP组和非VAP组相比较,两组的血清清蛋白水平、血糖水平、APACHE II评分、胃内容物反流、机械通气时间、抗生素使用种类差异均有统计学意义（χ2=13.019,11.793,9.932,8.957,20.057,28.884,均P＜0.05）,其它资料差异均无统计学意义（P＞0.05）。②VAP组和非VAP组1天血清指标差异无统计学意义（t=0.928~1.315,均P＞0.05）。与非VAP组相比,VAP组的3,5和7天 PCT,sTREM-1和YKL-40水平显著升高（t=15.203~37.340,均P＜0.001）。③Logistic回归分析表明:年龄≥60岁,血清清蛋白＜30g/L,血糖水平≥7.8mmol/L,广谱抗生素使用种类≥3种,胃内容物反流、气管切开,机械通气时间≥5天,APACHE II评分≥15分,PCT水平升高,sTREM-1水平升高,YKL-40水平升高均是发生VAP的危险因素（χ2=4.404~14.185,均P＜0.05）。④生存组和死亡组1天PCT,sTREM-1和YKL-40水平差异无统计学意义（t=1.191,0.842和1.838,均P＞0.05）,3,5和7天死亡组三个血清学指标显著高于存活组（t=13.342~26.950,均P＜0.001）。⑤3,5和7天 PCT,sTREM-1,YKL-40水平联合检测均具有较好的敏感度和特异度,对VAP患者的预后均有较高的诊断价值（AUC:0.879~0.945）。结论　 血清PCT,sTREM-1和YKL-40水平升高是ICU呼吸机通气患者发生VAP的危险因素,临床进行动态监测可对VAP患者的预后进行良好的预测,有效地改善VAP患者的预后生存。     

白芍总苷治疗非活动期强直性脊柱炎机制研究

目的初步探讨白芍总苷胶囊（TGP）治疗非活动期强直性脊柱炎（AS）的机制。方法选择38例非活动期的AS患者,分别采用非甾体抗炎药（NSAID）、NSAID加TGP、TGP治疗,同时纳入15名健康体检者作对照。于基线期、用药24周后检测其CRP、ESR、ALT、AST、血尿素氮、血清肌酐浓度,记录视觉模拟评分（VAS）、巴氏AS病情活动指数（BASDAI）、巴氏AS功能指数（BASFI）、AS疾病活动指数（ASDAS）,逆转录PCR检测外周血Toll样受体-4（TLR-4）、TLR-5、髓样分化因子MYD88、TNF受体相关因子6（TRAF6）mRNA的表达,液相芯片仪检测血清TNF-α、IL-17α、转化生长因子-β1（TGF-β1）浓度。结果治疗期间3组AS患者复发率比较差异无统计学意义,用药24周后3组组间临床评分及炎症指标无明显变化（P均〉0.05）。治疗前3组AS患者TLR-4、TLR-5 mRNA表达水平较健康对照组升高（P〈0.05）。用药24周后合并用药组TLR-4 mRNA、TLR-5 mRNA表达降低（P〈0.05）,单用TGP组TLR-5 mRNA表达降低（P〈0.05）。3组AS患者基线期血清TNF-α、IL-17α、TGF-β1浓度较健康对照组升高（P〈0.05）,用药24周后,各组AS患者血清TNF-α、IL-17α浓度下降（P〈0.05）。结论 TGP对非活动期AS有治疗前景,其作用机制可能为下调相关炎症因子及调控TLR-4、TLR-5介导的炎症反应。     

原发性高血压患者血清Ficolin-3，CysC和Hcy水平与颈动脉内膜中层厚度的相关性分析

目的　观察原发性高血压（essential hypertension，EH）患者血清纤维胶凝蛋白3（ficolin 3，FCN3）、胱抑素C（cystatin C，Cys C）、同型半胱氨酸（homocysteine，Hcy）水平与颈动脉内膜中层厚度（intima-mediathickness，IMT）的相关性，以此为临床诊断、治疗提供参考依据。方法　回顾性分析2018 年1 月~2019 年12 月于河南科技大学第一附属医院接受治疗的80 例EH 患者临床资料，根据彩色多普勒超声检测的IMT 结果将38 例IMT ＜ 1.0mm 的患者作为正常组，将42 例IMT ≥ 1.0mm 患者作为异常组。比较两组患者血清FCN3，Cys C 和Hcy 水平，并分析血清FCN3，Cys C 和Hcy 水平与患者IMT 的相关性。结果　异常组患者血清FCN3 水平低于正常组，差异有统计学意义（t=5.930，P ＜ 0.05）；异常组患者血清Cys C 和Hcy 水平高于正常组，差异有统计学意义（t=12.469，33.204，均P ＜ 0.05）；相关性分析发现，EH 患者的血清FCN3 水平与IMT 呈负相关（r=-0.433，P ＜ 0.05），血清Cys C，Hcy 水平与IMT呈正相关（r=0.825，0.887，均P ＜ 0.05）。结论　EH 患者血清FCN3，Cys C 和Hcy 水平与IMT 密切相关，FCN3 低表达，Cys C 和Hcy 高表达提示了EH 患者存在心血管疾病的风险，可将其纳入对EH 心脑血管疾病发生风险的评估及防治中来。     

强直性脊柱炎中血清高迁移率族蛋白 B1和肿瘤坏死因子α的表达与疾病相关性的研究

目的：探讨强直性脊柱炎（AS）患者血清高迁移率族蛋白 B1（HMGB1）和肿瘤坏死因子α（TNFα）的表达及其与疾病活动的相关性,以寻找治疗 AS 新靶点。方法本研究纳入50名 AS 患者,其中30例为初诊未治疗活动期患者,20例为治疗三个月稳定期患者。从同地区选取性别、年龄和种族与疾病组配对的30名正常志愿者作为健康对照。通过 ELISA 方法测定不同组别的血清 HMGB1与 TNFα的表达,检测治疗前后与对照组血清 HMGB1与 TNFα的表达水平,比较分析 AS 患者 HMGB1与 TNFα变化以及其与炎性指标、AS 躯体功能指数 BASFI 和 AS 活动性指数 BASDAI 之间的相关性。结果AS 患者血清中 HMGB1和 TNFα水平明显高于正常组,稳定期较活动期患者二者水平明显下降,但仍高于健康对照组;AS 患者血清中 HMGB1和 TNF-α水平均与血沉、超敏 C 反应蛋白（hsCRP）、BASFI、BASDAI 呈正相关;AS 患者血清中 HMGB1和 TNFα水平呈明显的正相关。结论AS 中 HMGB1与 TNFα的表达升高,与疾病活动性正相关,且两种因子有较强的正相关性,HMGB1在 AS 的发病中可能扮演了重要角色。     

脊柱关节炎患者血清中25-(OH)D3，t-PINP，b-CTx 水平表达及临床相关性研究

目的　探讨脊柱关节炎（SpA）患者血清中25 羟基维生素D3[25-(OH)D3]、总I 型前胶原氨基端肽（t-PINP） 和I 型胶原C 端肽（β-CTx）的水平及与疾病活动度的相关性、中西医结合治疗前后水平变化。方法　选择2018 年 6 月~2019 年6 月在四川省骨科医院就诊且初次诊断为SpA 患者120 例作为病例组，其中包括强直性脊柱炎（AS） 患者60 例、放射学阴性脊柱关节炎（nr-ax SpA）患者30 例和外周型SpA 患者30 例，同时选择40 例健康体检者作 为对照组，检测血清中25-(OH)D3，t-PINP 和β-CTx 的水平。根据Bath 强直性脊柱炎活动性指数（BASDAI）评 分将SpA 患者分为疾病活动组（BASDAI>4.0）及非活动组（BASDAI ≤ 4.0），比较病例组与对照组、SpA 患者疾 病活动组与非活动组25-(OH)D3，t-PINP 和β-CTx 水平的差异，及随访40 例SpA 患者治疗前后水平的变化。结果　 SpA 患者25-(OH)D3 水平低于对照组，t-PINP 和β-CTx 水平高于对照组，差异均有统计学意义（t=7.520,4.118,4.128, 均P<0.05）， 而AS，nr-ax SpA， 外周型SpA 患者之间三个指标的差异无统计学意义（F=0.070~0.236, 均 P>0.05）。在AS，nr-ax SpA 和外周型SpA 中，疾病活动组t-PINP，β-CTx 高于非活动组，25-(OH)D3 水平只有 AS 组降低（P<0.05），且t-PINP，β-CTx 水平与BASDAI 评分呈正相关。随访40 例SpA 患者接受中西医结合 治疗3 个月后25-(OH)D3 水平升高，t-PINP，β-CTx 水平降低（P<0.05）。结论　SpA 患者外周血中存在25-(OH) D3，t-PINP 和β-CTx 水平的异常表达，在疾病活动期表现得更加明显。检测25-(OH)D3，t-PINP 和β-CTx 水平对 SpA 患者疾病活动性及病情监测具有一定的价值。     

阿托伐他汀对射血分数保留心力衰竭患者YKL-40及心功能的影响

目的：探讨几丁质酶-3样蛋白-1（YKL-40）在射血分数保留心力衰竭（HFPEF）患者诊断和评估病情严重程度中的临床价值及阿托伐他汀治疗HFPEF的有效性。方法选择70例HF-PEF患者及35名健康体检者，均于入组时测定血脂及 YKL-40水平，并进行6 min 步行试验（6MWT）。将70例HFPEF患者随机分为阿托伐他汀组35例（在基础治疗上予阿托伐他汀20 mg/d）、对照治疗组35例（仅予基础治疗），并于治疗12个月后再次检测2组患者的血清YKL-40、血脂水平及进行6 MWT。结果治疗前，阿托伐他汀组及对照治疗组患者YKL-40水平均明显高于健康对照组（P＜0.05），且YKL-40水平与6MWT呈负相关（rs ＝-0.999，P＜0.05）。治疗12个月时阿托伐他汀组YKL-40水平比对照治疗组下降更为明显，且6 MWT改善更明显（P均＜0.05）。结论阿托伐他汀能够进一步降低HFPEF患者血清YKL-40水平及改善心功能，YKL-40在评价心功能方面有一定的临床价值。     

脓毒症患者血清 YKL-40 水平检测与急性肾损伤早期诊断的相关性研究

目的　探究脓毒症患者血清人类软骨糖蛋白 -39(YKL-40) 水平检测与急性肾损伤 (acute kidney injury, AKI) 早期诊断的相关性研究。方法　选择 2018 年 7 月～ 2020 年 2 月西安高新医院急诊科收治的 170 例脓毒症患者为研究对象，根据患者入住 ICU 后 24 h 内是否发生 AKI 分为 AKI 组和非 AKI 组。采用酶联免疫吸附法 (ELISA) 检测血清 YKL40 的水平。结果 AKI 组和非 AKI 组的平均年龄、吸烟史、饮酒史、白细胞计数 (white blood cell count, WBC) 比较差异均无统计学意义 (t=0.37,χ2=1.71,χ2=0.90,t=0.67, 均 P ＞ 0.05)，AKI 组的血肌酐 (serum creatinine, SCr) 和 YKL-40 水平均高于非 AKI 组，其差异均有统计学意义 (χ2=5.97，10.11，均 P ＜ 0.05)。脓毒症伴 AKI- Ⅲ期患者血清 YKL-40 水平高于脓毒症伴 AKI- Ⅱ期和 AKI- Ⅰ期，脓毒症伴 AKI- Ⅱ期显著高于 AKI- Ⅰ期，其组间差异具有统计学意义 (F=1.37，P=0.00)。Pearson 相关法分析结果显示，血清 YKL-40 水平与 SCr 和 AKI 分期呈正相关关系 (r= 0.19，0.25，P=0.00)。ROC 曲线分析结果显示，区别诊断 AKI 及非 AKI 患者时，血清 YKL-40 的 AUC 为 0.88(95%CI 0.81~0.94)，当 cut-off值为 4.20 ng/mg 时，特异度和灵敏度分别为 0.75 和 0.78。区别诊断脓毒症伴 AKI- Ⅲ期与 AKI-Ⅰ/Ⅱ期患者时，血清YKL-40 的 AUC 为 0.82(95%CI 0.71~0.94)，当 cut-off 值为 6.79 ng/mg 时，特异度和灵敏度分别为 0.83 和 0.72。结论血清 YKL-40 在脓毒症伴 AKI 患者中高表达，可用于诊断 AKI 和判断 AKI 的严重程度。     

雷公藤多苷联合柳氮磺吡啶治疗强直性脊柱炎患者疗效观察

目的：分析雷公藤多苷+柳氮磺吡啶治疗强直性脊柱炎（AS）的效果。方法：选取2019年2月~2020年8月收治的AS患者92例,按照随机数字表法分为常规组和研究组各46例。两组均给予基础治疗,常规组接受柳氮磺吡啶治疗,研究组接受柳氮磺吡啶+雷公藤多苷治疗。比较两组疗效、Bath强直性脊柱炎功能指数（BASFI）评分、Bath强直性脊柱炎疾病活动性指数（BASDAI）评分以及白细胞介素-10（IL-10）、白细胞介素-4（IL-4）、肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）水平。结果：研究组总有效率93.48%较常规组76.09%高（P＜0.05）;治疗后两组BASFI及BASDAI评分均下降,且研究组评分更低（P＜0.05）;治疗后两组IL-10、IL-4水平均升高,IL-1β、TNF-α水平均下降,且研究组IL-10、IL-4水平均更高,IL-1β、TNF-α水平均更低（P＜0.05）。结论：雷公藤多苷联合柳氮磺吡啶治疗AS疗效显著,能有效调节炎症免疫,缓解病情。     

Pharmacokinetics of ethambutol under fasting conditions, with food, and with antacids

Ethambutol (EMB) is the most frequent "fourth drug" used for the empiric treatment of Mycobacterium tuberculosis and a frequently used drug for infections caused by Mycobacterium avium complex. The pharmacokinetics of EMB in serum were studied with 14 healthy males and females in a randomized, four-period crossover study. Subjects ingested single doses of EMB of 25 mg/kg of body weight under fasting conditions twice, with a high-fat meal, and with aluminum-magnesium antacid. Serum was collected for 48 h and assayed by gas chromatography-mass spectrometry. Data were analyzed by noncompartmental methods and by a two-compartment pharmacokinetic model with zero-order absorption and first-order elimination. Both fasting conditions produced similar results: a mean (+/- standard deviation) EMB maximum concentration of drug in serum (Cmax) of 4.5 +/- 1.0 micrograms/ml, time to maximum concentration of drug in serum (Tmax) of 2.5 +/- 0.9 h, and area under the concentration-time curve from 0 h to infinity (AUC0-infinity) of 28.9 +/- 4.7 micrograms.h/ml. In the presence of antacids, subjects had a mean Cmax of 3.3 +/- 0.5 micrograms/ml, Tmax of 2.9 +/- 1.2 h, and AUC0-infinity of 27.5 +/- 5.9 micrograms.h/ml. In the presence of the Food and Drug Administration high-fat meal, subjects had a mean Cmax of 3.8 +/- 0.8 micrograms/ml, Tmax of 3.2 +/- 1.3 h, and AUC0-infinity of 29.6 +/- 4.7 micrograms.h/ml. These reductions in Cmax, delays in Tmax, and modest reductions in AUC0-infinity can be avoided by giving EMB on an empty stomach whenever possible.     

Gait comparison of subjects with hemiplegia walking unbraced, with ankle-foot orthosis, and with Air-Stirrup brace

The effects of the Air-Stirrup (AS) standard ankle brace on the gait of 19 subjects with hemiplegia resulting from a cerebrovascular accident who exhibited excessive subtalar joint motion were studied. Videotaped trials and footprint analyses were used to measure subjects' hip, knee, and ankle sagittal plane angles; inversion and eversion of the calcaneus; and time-distance gait characteristics. A one-way analysis of variance for repeated measures was used to compare the gait of 19 subjects with the AS brace and unbraced and 11 subjects with the AS brace, unbraced, and with an ankle-foot orthosis. The AS brace was associated with more calcaneal stability during standing than the unbraced condition. The ankle-foot orthosis was associated with less plantar flexion at foot-strike than either the AS brace or unbraced condition. Both the AS brace and the ankle-foot orthosis were associated with less mid-swing plantar flexion and increased step length on the paretic side compared with no brace. These results support the effectiveness of the AS brace in controlling inversion and eversion instability in patients with hemiplegia.     

Compatibility of ropivacaine with morphine, sufentanil, fentanyl, or clonidine

BACKGROUND: Ropivacaine hydrochloride (HCl) ('Naropin') is a long-acting local anaesthetic agent, administered epidurally to patients undergoing various surgical procedures. A combination of local anaesthetic and opioid is often administered for the management of severe pain to ensure that a minimal dose of each is used. Ropivacaine might be used in combination with an alpha2-adrenergic agonist for the management of visceral pain. Stability data have shown that ropivacaine is compatible with the systemic narcotic opioid analgesics morphine sulphate, sufentanil citrate and fentanyl citrate for 14 days in a Polybag (AstraZeneca-AB, Sweden), but no data have been obtained for the longer-term compatibility of ropivacaine with these opioids or with the alpha2-adrenergic agonist clonidine HCl. OBJECTIVE: This study used the Mark II Polybag (AstraZeneca-AB, Sweden) to test the physical and chemical compatibility of these products for up to 30 days. METHODS: Ropivacaine HCl solution for epidural infusion, 2 mg/mL, in 200 mL Mark II Polybag and commercially available additives in glass ampoules or vials were used as starting material. Appropriate admixtures were made and their appearance, pH, and drug concentrations were monitored on days 0, 7, 14, and 30. The appearance of the admixtures was examined with the aid of a stereomicroscope (Olympus, no. 220186, New York, USA) at 10x magnification. Drug concentration and enantiomeric purity were determined using high-performance liquid chromatographic analysis. RESULTS: All combinations at all doses stayed within the compatibility criteria (if no visible signs of physical changes in the admixture appeared throughout the 30 days of storage, and if pH and drug concentrations in each admixture did not vary by more than 10% between day 0 and days 7, 14, or 30 in storage). In addition, there were no important differences in the enantiomeric purity of ropivacaine with each combination. CONCLUSION: The study demonstrated that ropivacaine was suitable for use in combination with the opioids morphine sulphate, sufentanil citrate, and fentanyl citrate, or with the alpha2-adrenergic agonist clonidine HCl, for up to 30 days of storage before the management of severe or visceral pain. From a microbiological point of view, combinations not prepared under aseptic conditions should be used immediately. 'Naropin' is a trade mark of the AstraZeneca group of companies.     

Health, education, work, and independence of young adults with disabilities

PURPOSE: Healthy People 2010, the U.S. government's goal for a healthier nation, calls for improved data collection to understand the health status of relatively small population groups, such as young adults with disabilities. This study looks at the transition outcomes of graduates of pediatric systems of care for children with disabilities and chronic conditions. METHODS: Young adult graduates of a state program for children with special healthcare needs and a specialty children's hospital were sent a mail survey that focused on their healthcare access and use, insurance status, health behaviors and perceptions, education, work, and markers of independent living. The survey was based on the , National Longitudinal Survey of Youth, Behavioral Risk Factor Surveillance System, the U.S. Census and other surveys done by the state and hospital programs. Experts in healthcare and school-to-work transition of youth with special needs, health and labor economists, independent living center counselors, program administrators, nurses, social workers, and physicians offered ideas on various versions of the instrument that were piloted on youth before mailing to graduates. A follow-up mailing was sent to all those who did not respond to the first mailing. Results from the surveys of these young people with special healthcare needs are compared with data on typical young adults to determine the disparities. SAMPLE: Mail surveys were sent to all patients aged 18 years and older at the time of their discharge in the preceding fiscal (state program) or calendar (children's hospital) year. The response rate was 51%. Ninety-one percent of the respondents were Whites and 61% were women, with a median age of 21.1 years; 69% reported independence in activities of daily living. RESULTS AND DISCUSSION/CLINICAL RESULTS: Eighty percent of graduates reported having a usual source of care, but 42% used the emergency room compared with 25% of typical young adults. Twenty-nine percent had no health insurance and only 11% had insurance through their work. Only 44% of respondents were working compared with 56% of all 19 year olds and 72% of 18-29 year olds in studies of typical youth; 67% of those not working wanted to work. One great concern is the 26% who are not working, in school, or at home with children. Nurses working with children, families, and young adults can use the information to improve pediatric and adult healthcare systems and collaborate with educational, independent living, and workforce development agencies to improve transition to adult roles and responsibilities for young people with disabilities.     

Earthworms of Hyderabad-Karnataka Province,Karnataka, India,with Two New Records

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - Hyderabad-Karnataka region is the second arid region after parts of Rajasthan in India. In this study,...     

Association of Alzheimer's dementia with oral bacteria,vitamin B12, folate,homocysteine levels,and insulin resistance along with its pathophysiology,genetics, imaging,and biomarkers

Alzheimer's disease is a prevalent form of dementia, particularly among the elderly population. It is characterized by progressive cognitive decline and neurodegeneration. Despite numerous studies, the exact cause of Alzheimer's disease remains uncertain, and various theories have been proposed, including Aβ amyloid deposition in the brain and tau protein hyper-phosphorylation. This review article explores the potential pathogenesis of Alzheimer's disease, focusing on the effects of derangements in the levels of vitamin B12, folate, and homocysteine, as well as the impact of oral bacteria causing periodontitis and insulin resistance, and their relationship to Alzheimer's. Studies have shown that high levels of homocysteine and low levels of vitamin B12 and folate, are associated with an increased risk of developing Alzheimer's disease. The article also explores the link between Alzheimer's disease and oral bacteria, specifically dental infections and periodontitis, which contribute to the inflammatory processes in the nervous system of Alzheimer's patients. There could be derangement in the insulin signaling further causing disruption in glucose metabolism within the brain, suggesting that Alzheimer's disease may represent a form of type 2 diabetes mellitus associated with the brain, commonly known as type 3 diabetes. Neuroimaging techniques, including MRI, PET, and tau PET, can identify the predictive characteristics of Alzheimer's disease, with amyloid PET being the most useful in ruling out the disease. The article concludes by stressing the importance of understanding genetic and neuroimaging factors in the diagnosing and treating Alzheimer's disease.