The Effectiveness of Dietary-Induced Ketogenesis on Cognition in Older Adults: A Scoping Review of the Literature

There is growing interest in the effect of dietary interventions in people living with memory impairment and delaying cognitive decline. Investigation of alterations in glucose metabolism and dietary-induced ketogenesis in older adults is a recent growing area of research. Ketone bodies are an important alternative energy source in the brain and may be beneficial to people developing or who already have memory impairment or those with Alzheimer’s disease. This scoping review aims to evaluate the available evidence on dietary-induced ketogenesis and its effect on cognition in older adults and the factors affecting feasibility of the dietary interventions to inform the design of future studies. The scoping review methodology explored the current knowledge about dietary interventions related to dietary-induced ketogenesis and cognition in older adults and identify gaps in the literature. Eleven dietary intervention studies included in the review demonstrated that both medium-chain triglyceride supplementation and ketogenic diets induce ketosis. Nine of these studies demonstrated that dietary-induced ketogenesis could lead to an improvement in cognitive functions, but the evidence remains inconclusive. Most of the included studies showed evidence to suggest that dietary-induced ketogenesis improves cognitive functions in older adults. However, the number of published papers is small and there were differences in the design and types of the dietary interventions (medium-chain triglyceride supplementation, ketogenic diet) along with high drop-out rates in some studies which limits the generalization of the findings. Although methodologies used in the studies vary, the findings warrant the need for further research with larger sample sizes in people at different stages of cognitive impairment, and to develop strategies to improve adherence to the intervention

EFFICIENT AND FAST GAUSSIAN BEAM-TRACKING APPROACH FOR INDOOR-PROPAGATION MODELING

International audienceA Gaussian beam-tracking technique is proposed for physical indoor-propagation modeling. Its efficiency stems from the collective treatment of rays, which is realized by using Gaussian beams to propagate fields. The formulation of this method is outlined, the computation-time efficiency is discussed, and the simulation results are compared to those obtained using a commercial ray-tracing software (XSiradif)

Adverse drug events associated with vitamin K antagonists: factors of therapeutic imbalance

Nancy El-Helou, Amal Al-Hajje, Rola Ajrouche, Sanaa Awada, Samar Rachidi, Salam Zein, Pascale SalamehClinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, LebanonBackground: Adverse drug events (ADE) occur frequently during treatment with vitamin K antagonists (AVK) and contribute to increase hemorrhagic risks.Methods: A retrospective study was conducted over a period of 2 years. Patients treated with AVK and admitted to the emergency room of a tertiary care hospital in Beirut were included. The aim of the study was to identify ADE characterized by a high international normalized ratio (INR) and to determine the predictive factors responsible for these events. Statistical analysis was performed with the SPSS statistical package.Results: We included 148 patients. Sixty-seven patients (47.3%) with an INR above the therapeutic range were identified as cases. The control group consisted of 81 patients (54.7%) with an INR within the therapeutic range. Hemorrhagic complications were observed in 53.7% of cases versus 6.2% of controls (P < 0.0001). No significant difference was noticed between cases and controls regarding the indication and the dose of AVK. Patients aged over 75 years were more likely to present an INR above the therapeutic range (58.2%, P = 0.049). Recent infection was present in 40.3% of cases versus 6.2% of controls (P < 0.0001) and hypoalbuminemia in 37.3% of cases versus 6.1% of controls (P < 0.0001). Treatment with antibiotics, amiodarone, and anti-inflammatory drugs were also factors of imbalance (P < 0.0001).Conclusion: Many factors may be associated with ADE related to AVK. Monitoring of INR and its stabilization in the therapeutic range are important for preventing these events.Keywords: adverse drug events, vitamin K antagonists, bleeding risks, therapeutic imbalanc

The Effectiveness of Dietary-Induced Ketogenesis on Cognition in Older Adults: A Scoping Review of the Literature

There is growing interest in the effect of dietary interventions in people living with memory impairment and delaying cognitive decline. Investigation of alterations in glucose metabolism and dietary-induced ketogenesis in older adults is a recent growing area of research. Ketone bodies are an important alternative energy source in the brain and may be beneficial to people developing or who already have memory impairment or those with Alzheimer’s disease. This scoping review aims to evaluate the available evidence on dietary-induced ketogenesis and its effect on cognition in older adults and the factors affecting feasibility of the dietary interventions to inform the design of future studies. The scoping review methodology explored the current knowledge about dietary interventions related to dietary-induced ketogenesis and cognition in older adults and identify gaps in the literature. Eleven dietary intervention studies included in the review demonstrated that both medium-chain triglyceride supplementation and ketogenic diets induce ketosis. Nine of these studies demonstrated that dietary-induced ketogenesis could lead to an improvement in cognitive functions, but the evidence remains inconclusive. Most of the included studies showed evidence to suggest that dietary-induced ketogenesis improves cognitive functions in older adults. However, the number of published papers is small and there were differences in the design and types of the dietary interventions (medium-chain triglyceride supplementation, ketogenic diet) along with high drop-out rates in some studies which limits the generalization of the findings. Although methodologies used in the studies vary, the findings warrant the need for further research with larger sample sizes in people at different stages of cognitive impairment, and to develop strategies to improve adherence to the intervention

Catastrophic Antiphospholipid Syndrome

This paper reports one case of successfully treated patients suffering from a rare entity, the catastrophic antiphospholipid syndrome (CAPS). Management of this patient is discussed in detail

Evaluating the governance and preparedness of the Lebanese health system for the COVID-19 pandemic: a qualitative study

From BMJ via Jisc Publications RouterHistory: received 2021-10-29, accepted 2022-05-16, ppub 2022-06, epub 2022-06-01Publication status: PublishedFunder: World Health Organization; FundRef: http://dx.doi.org/10.13039/100004423; Grant(s): 2002577199Objectives: This study aimed to assess the capacities and governance of Lebanon’s health system throughout the response to the COVID-19 pandemic until August 2020. Design: A qualitative study based on semi-structured interviews. Setting: Lebanon, February–August 2020. Participants: Selected participants were directly or indirectly involved in the national or organisational response to the COVID-19 pandemic in Lebanon. Results: A total of 41 participants were included in the study. ‘Hardware’ capacities of the system were found to be responsive yet deeply influenced by the challenging national context. The health workforce showed high levels of resilience, despite the shortage of medical staff and gaps in training at the early stages of the pandemic. The system infrastructure, medical supplies and testing capacities were sufficient, but the reluctance of the private sector in care provision and gaps in reimbursement of COVID-19 care by many health funding schemes were the main concerns. Moreover, the public health surveillance system was overwhelmed a few months after the start of the pandemic. As for the system ‘software’, there were attempts for a participatory governance mechanism, but the actual decision-making process was challenging with limited cooperation and strategic vision, resulting in decreased trust and increased confusion among communities. Moreover, the power imbalance between health actors and other stakeholders affected decision-making dynamics and the uptake of scientific evidence in policy-making. Conclusions: Interventions adopting a centralised and reactive approach were prominent in Lebanon’s response to the COVID-19 pandemic. Better public governance and different reforms are needed to strengthen the health system preparedness and capacities to face future health security threats

Multiplexed Immunofluorescence Analysis and Quantification of Intratumoral PD-1+ Tim-3+ CD8+ T Cells

Immune cells are important components of the tumor microenvironment and influence tumor growth and evolution at all stages of carcinogenesis. Notably, it is now well established that the immune infiltrate in human tumors can correlate with prognosis and response to therapy. The analysis of the immune infiltrate in the tumor microenvironment has become a major challenge for the classification of patients and the response to treatment. The co-expression of inhibitory receptors such as Program Cell Death Protein 1 (PD1; also known as CD279), Cytotoxic T Lymphocyte Associated Protein 4 (CTLA-4), T-Cell Immunoglobulin and Mucin Containing Protein-3 (Tim-3; also known as CD366), and Lymphocyte Activation Gene 3 (Lag-3; also known as CD223), is a hallmark of T cell exhaustion. We developed a multiparametric in situ immunofluorescence staining to identify and quantify at the cellular level the co-expression of these inhibitory receptors. On a retrospective series of frozen tissue of renal cell carcinomas (RCC), using a fluorescence multispectral imaging technology coupled with an image analysis software, it was found that co-expression of PD-1 and Tim-3 on tumor infiltrating CD8 T cells is correlated with a poor prognosis in RCC. To our knowledge, this represents the first study demonstrating that this automated multiplex in situ technology may have some clinical relevance

Atomic excitation during recollision-free ultrafast multi-electron tunnel ionization

Modern intense ultrafast pulsed lasers generate an electric field of sufficient strength to permit tunnel ionization of the valence electrons in atoms. This process is usually treated as a rapid succession of isolated events, in which the states of the remaining electrons are neglected. Such electronic interactions are predicted to be weak, the exception being recollision excitation and ionization caused by linearly-polarized radiation. In contrast, it has recently been suggested that intense field ionization may be accompanied by a two-stage `shake-up' reaction. Here we report a unique combination of experimental techniques that enables us to accurately measure the tunnel ionization probability for argon exposed to 50 femtosecond laser pulses. Most significantly for the current study, this measurement is independent of the optical focal geometry, equivalent to a homogenous electric field. Furthermore, circularly-polarized radiation negates recollision. The present measurements indicate that tunnel ionization results in simultaneous excitation of one or more remaining electrons through shake-up. From an atomic physics standpoint, it may be possible to induce ionization from specific states, and will influence the development of coherent attosecond XUV radiation sources. Such pulses have vital scientific and economic potential in areas such as high-resolution imaging of in-vivo cells and nanoscale XUV lithography.Comment: 17 pages, 4 figures, original format as accepted by Nature Physic

Physics Opportunities with the 12 GeV Upgrade at Jefferson Lab

This white paper summarizes the scientific opportunities for utilization of the upgraded 12 GeV Continuous Electron Beam Accelerator Facility (CEBAF) and associated experimental equipment at Jefferson Lab. It is based on the 52 proposals recommended for approval by the Jefferson Lab Program Advisory Committee.The upgraded facility will enable a new experimental program with substantial discovery potential to address important topics in nuclear, hadronic, and electroweak physics.Comment: 64 page