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We sought to assess the impact on groundwater of using three types of saline waters to irrigate the halophyte Salicornia bigelovii Torrey in the hyper-arid United Arab Emirates. These were groundwater (GW) at 25 dS m−1, reverse-osmosis brine (RO) from a desalination unit at 40 dS m−1, and the aquabrine (AQ) effluent from land-based aquaculture in tanks filled with RO brine, also at 40 dS m−1. The three waters were applied through bubblers (BUB), pressure-compensated drippers (PCD), or subsurface irrigation tape (SUB). The yields of Salicornia fresh tips, harvest forage, and seed were greatest for AQ applied through BUB, being 650 g m−2. We found 2–2.6 kg m−2 for dry forage yield with AQ through BUB, compared with 1–2.3 kg m−2 for the other waters and emitter devices. The highest water productivities WPI (kg m−3) across all three crop-outputs came from Aquabrine applied by pressure-compensated drippers. We assessed the gross economic water productivity (GEWPI, $ m−3) based solely on gross revenue. The GEWPI was highest for AQ applied through PCD and SUB, namely 5.8–6.2 $ m−3. The value derives primarily from fresh tips. The GEWPl was well above the cost of desalination at $1.5 m−3. We measured drainage and leaching using fluxmeters. The greatest salt load to groundwater came from BUB, being 135–195 kg m−2. For PCD and SUB it was between 14 and 36 kg m−2. Mass-balance calculations of these salt loadings can predict the impact on the saline quality of aquifers. We used an exemplar loading of 75 kg m−2, and results in an annual salinity rise of 2.6 dS m−1 y−1 for an aquifer of saturated depth of 100 m. This significant rate of rise in the salinity of groundwater would represent a continuing deterioration in the utility of groundwater.

Plantain (Plantago lanceolata L.) has been identified by the New Zealand dairy sector as an option for reducing nitrogen losses from grazed pastures. However, there is growing concern over its poor persistence. Reports have suggested that plantain does not tolerate waterlogged soils; however, there is little scientific evidence to support those claims. Thus, the present study aimed to investigate the impact of waterlogging on plantain growth and survival. In a glasshouse, three water treatments were applied to plantain plants in pots: control (soil water below field capacity but not limited), wet (soil water marginally above field capacity), and waterlogged (water table 5 cm below the surface) for 39 days, followed by 27 days under the control watering treatment. Leaf elongation and photosynthesis were measured during the experiment. The mean leaf elongation rate of waterlogged plants was 37% lower than control plants during the stress period, but not significantly different than control plants during the recovery period. Waterlogging reduced the rate of photosynthesis in plantain leaves by 15% on average in comparison with control watering during the stress period; however, waterlogged and control plants had a similar mean photosynthesis rate during the recovery period. The results show that plantain growth and photosynthesis were significantly limited under waterlogging; however, the rapid recovery of both processes following the removal of stress suggests that important physiological functions remained intact under waterlogging, possibly due to tolerance mechanisms. These findings suggest that while waterlogging may cause limitations for plantain growth, there is no evidence to suggest that it alone could cause irreversible damage to plants and thus prevent their recovery. Rather, waterlogging stress could undermine the ability of plantain to compete with species that are tolerant of waterlogging within mixed pastures.

The objective of this study was to determine the effect of grazing plantain-based pastures on urine volume, urination frequency, and urinary nitrogen (UN) concentration of dairy cows under a typical pastoral dairy practice offering approximately 25% supplemented feeds. The experiment was a completely randomised design with three pasture treatments (perennial ryegrass–white clover (RGWC); RGWC + low plantain rate (PLL); and RGWC + high plantain rate (PLH)), five replicate plots, and repeated in two sequential grazing periods. Forty-five lactating Friesian × Jersey cows were randomly assigned into three groups of 15 animals each to graze over six days in adaptation paddocks and three days in experimental plots. Urine flow sensors were used to measure urine volume and urinary frequency, while spot urine sampling was conducted to determine nitrogen (N) concentration in cow urine. The results showed that including 25% plantain in the diet (PLH) increased daily urine volume by 44% and the daily number of urinations by 28%, compared to grazing the RGWC pasture. In addition, N concentration in cow urine was decreased by 18 and 29% when the diet contained 18% and 25% plantain, respectively. In conclusion, under a typical dairy farm practice, incorporating plantain into the RGWC pasture with the proportion of 25% plantain in the diet can increase the number of urine patches and reduce the concentration of N in the urine, thereby providing the opportunity to decrease N leaching from pastoral systems.

The use of plantain pasture in dairy systems can potentially reduce nitrogen (N) leaching losses via the lower N concentration in the urine (UNc) of cows. Reducing the urinary N load while cows graze pastures can reduce the risk of N leaching losses from urine patches. Research needs to demonstrate that these environmental benefits are not at the expense of milk production and farm profit. Three groups of 20 cows grazed in the following three pasture treatments: (i) plantain, (ii) plantain–clover mix (plantain, red [Trifolium pratense] and white clover), or (iii) ryegrass-white clover (wc) pastures, from spring to autumn for two years. Each year, pasture intake, diet quality, milk production and animal N (milk and urine) excretion were evaluated in spring, summer, and autumn. The cows grazing the plantain and plantain–clover mix pastures produced similar milk solids as cows grazing ryegrass–wc pasture but reduced their UNc during summer and autumn, when compared to those grazing the plantain–clover mix and ryegrass–wc pastures. Plantain reduced urinary N loads onto pastures by a greater number of urine patches with lower urinary N loading rates. The results demonstrate that plantain pastures do not diminish milk solids production from cows, and the lower UNc from summer to autumn could reduce N being lost to the environment.

In this study, we modelled and compared lactation curves of efficiency of crude protein utilisation (ECPU) and the nitrogen (N) excreta partitioning of milking cows of two contrasting spring-calving pasture-based herds to test some aspects of farming intensification practices on cow performance and N partition. In the low-intensity production system (LIPS), 257 cows were milked once-daily and fed diets comprised of pasture with low supplementary feed inclusion during lactation (304 kg pasture silage/cow). In the high-intensity production system (HIPS), 207 cows were milked twice-daily and fed pasture with higher supplementary feed inclusion (429 kg pasture silage and 1695 kg concentrate/cow). The dietary crude protein (CP) utilisation was calculated for each cow at every herd test date as the ECPU as a proportion of protein yield (PY) from the CP intake (CPI) derived from intake assessments based on metabolisable energy requirements, and the CP balance (CPB) calculated as the difference between CPI and PY. Total N excreta partitioned to faeces (FN) and urine (UN) was estimated by back-calculating UN from FN, considering dietary N, and from N retained in body tissues, taking into account live weight change during the lactation. The higher CPI (2.7 vs. 2.5 kg CP/day), along with the reduced milk yield (1100 kg milk/cow less), of the LIPS cows led to a lower ECPU (23% vs. 31%) and to a higher CPB (2.1 vs. 1.8 kg CP/day) when compared to the HIPS cows. Mean N excreta, and particularly UN, was significantly higher in LIPS cows, and this was explained by higher dietary CP and by the reduced PY when compared to the HIPS cows. Reducing the low-CP supplementation in the “de-intensified” herd lessened the ECPU, resulting in higher UN, which is sensitive in terms of body water eutrophication.

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Abstract Background In order to investigate microvascular complications in metabolic diseases, we aimed to investigate cerebral and peripheral microcirculation in relation to peripheral neuropathy and laboratory biomarkers in type 2 diabetes mellitus (T2DM) and obesity. Methods Based on the degree of neuropathy (NP), study participants (40 T2DM and 30 obese individuals) were classified into no-NP, mild-NP and severe-NP subgroups. After the injection of Technetium-99 m hexamethylpropylene amine oxime, both T2DM and obese participants underwent single-photon emission computed tomography/computed tomography ([99mTc]Tc-HMPAO SPECT/CT) and SPECT-only examinations to assess lower limb and brain perfusion; respectively. Peripheral nerve function was evaluated with a neurometer and glycaemic markers were measured from plasma in both groups. Results Compared to the obese individuals, lower extremity perfusion was significantly reduced in the diabetic subjects (p

IntroductionA higher incidence of neural dysfunction in people with obesity has been described. We determined the prevalence of neuropathic lesions in obese women and evaluated their potential association with anthropometric and laboratory parameters.Patients and methodsIn our cross-sectional study, we enrolled female patients with obesity and without diabetes before obesity treatment. Voluntary female subjects were controls with a normal body mass index (BMI). Autonomic function was assessed by Ewing’s cardiovascular reflex tests, while comprehensive peripheral neuropathic assessments were conducted utilizing the Neurometer®, Tiptherm®, Monofilament®, and Rydel-Seiffer tuning fork tests. Sudomotor function was assessed by the Neuropad®-test. Body composition was examined using the InBody 770.Results71 patients (mean ± SD; age: 36.1 ± 8.3 years; BMI: 40.2 ± 8.5 kg/m2) and 36 controls (age: 36.4 ± 13.3 years; BMI: 21.6 ± 2.1 kg/m2) were enrolled. Patients had significantly higher systolic (patients vs. controls; 137.5 ± 16.9 vs. 114.6 ± 14.8 mmHg, p

Background: Several validated clinical scales measure the severity of essential tremor (ET). Their assessments are subjective and can depend on familiarity and training with scoring systems. Method: We propose a multi-modal sensing using a wearable inertial measurement unit for estimating scores on the Fahn-Tolosa-Marin tremor rating scale (FTM) and determine the classification accuracy within the tremor type. 17 ET participants and 18 healthy controls were recruited for the study. Two movement disorder neurologists who were blinded to prior clinical information viewed video recordings and scored the FTM. Participants drew a guided Archimedes spiral while wearing an inertial measurement unit placed at the mid-point between the lateral epicondyle of the humerus and the anatomical snuff box. Acceleration and gyroscope recordings were analyzed. The ratio of the power spectral density between frequency bands 0.5-4 Hz and 4–12 Hz, and the sum of power spectrum density over the entire spectrum of 2–74 Hz, for both accelerometer and gyroscope data, were computed. FTM was estimated using regression model and classification using SVM was validated using the leave-one-out method. Results: Regression analysis showed a moderate to good correlation when individual features were used, while correlation was high ( $r^{2}$ = 0.818) when suitable features of the gyro and accelerometer were combined. The accuracy for two-class classification of the combined features using SVM was 91.42% while for four-class it was 68.57%. Conclusion: Potential applications of this novel wearable sensing method using a wearable Inertial Measurement Unit (IMU) include monitoring of ET and clinical trials of new treatments for the disorder.

Background Rapid detection of intracranial arterial occlusion in patients with ischemic stroke is important to facilitate timely reperfusion therapy. We compared the diagnostic accuracy of neurologists and radiologists against RapidAI (iSchema View, Menlo Park, CA) software for occlusion detection. Methods Adult patients who presented to a single comprehensive stroke center over a 5‐month interval with clinical suspicion of ischemic stroke and who underwent multimodality imaging with RapidAI interpretation were included. There were 8 assessors: 1 radiologist, 5 neurologists, and 2 radiology trainees. The reference standard was large‐vessel occlusion (LVO) or medium‐vessel occlusion (MVO) diagnosed by a panel of 4 interventional neuroradiologists. Positive likelihood ratio (LR) and negative LR were used to indicate how well readers correctly classified the presence of intracranial occlusions compared with the reference standard. The positive LR and negative LR for each reader were plotted on an LR graph using RapidAI LRs as comparator. Results The assessors read scans from 500 patients (49.6% men). The positive LR of RapidAI for detection of LVO was 8.49 (95% CI, 5.75–12.54), and the negative LR was 0.41 (95% CI, 0.28–0.58). The positive LR for LVO or MVO for RapidAI was 5.0 (95% CI, 3.28–7.63), and the negative LR was 0.66 (95% CI, 0.56−0.79). Sensitivity for LVO (0.65–0.96) and for LVO or MVO (0.62–0.94) was higher for all readers compared with RapidAI (0.62 and 0.39, respectively). Six of 8 readers had superior specificity to RapidAI for LVO (0.75–0.98 versus 0.93) and LVO or MVO (0.55–0.95 versus 0.92). Conclusions Experienced readers of acute stroke imaging can identify LVOs and MVOs with higher accuracy than RapidAI software in a real‐world setting. The negative LR of RapidAI software was not sufficient to rule out LVO or MVO.

The exact mechanism by which diabetic neuropathy develops is still not fully known, despite our advances in medical knowledge. Progressing neuropathy may occur with a persistently favorable metabolic status in some patients with diabetes mellitus, while, in others, though seldom, a persistently unfavorable metabolic status is not associated with significant neuropathy. This might be significantly due to genetic differences. While recent years have brought compelling progress in the understanding of the pathogenetic background—in particular, accelerated progress is being made in understanding molecular biological mechanisms—some aspects are still not fully understood. A comparatively small amount of information is accessible on this matter; therefore, by summarizing the available data, in this review, we aim to provide a clearer picture of the current state of knowledge, identify gaps in the previous studies, and possibly suggest directions for future studies. This could help in developing more personalized approaches to the prevention and treatment of diabetic neuropathy, while also taking into account individual genetic profiles.

IntroductionAutonomic and sensory neuropathy have been observed in both prediabetes and manifest diabetes mellitus. However, there is a lack of available data regarding whether patients at a moderate or high risk of developing diabetes, yet without a current diagnosis of prediabetes or diabetes, exhibit an increased prevalence of neuropathy.MethodsFINDRISC (Finnish Diabetes Risk Score) was used to classify individuals at risk (≥12 points, n = 44; control 5.6% served as exclusion criteria, and patients with known medical conditions predisposing to neuropathy were also excluded. Cardiac autonomic function (Ewing tests) and peripheral sensory neuropathy (Neurometer and Q-sense) were assessed by standardized protocols, and their potential association with increased FINDRISC points was analyzed using a regression model.ResultsMean age was 46.7 ± 14.3 years in the control and 55.7 ± 14.1 years in the increased risk group. Male/female ratio did not differ. Individuals with increased risk of diabetes were more obese (BMI: 29.9 ± 12.5 kg/m2 vs. 25.9 ± 8.9 kg/m2). Additionally, hypertension was more frequent among them (68.2% vs. 17.9%), and their lipid parameters were also less favorable. Parasympathetic neuropathy was present in both groups (56.8% vs. 32.1%, respectively). Sympathetic neuropathy was not found. Sensory nerve dysfunction was of low prevalence in the high-risk group and did not occur in healthy controls. In multiple logistic regression analysis, HbA1c exhibited an independent association with parasympathetic neuropathy (OR: 5.9; 95% CI: 1.08–32.68; p < 0.041).DiscussionAn increased risk of developing prediabetes/diabetes does not appear to have a strong correlation with an increased likelihood of developing autonomic or sensory neuropathy. However, the etiology behind the occurrence of parasympathetic autonomic neuropathy in healthy individuals remains unknown.

IntroductionVascular complications and neuropathy may develop in the presence of metabolic syndrome. The aim of our study was to measure the cardiovascular autonomic function following physical training in patients with metabolic syndrome with and without diabetes.Subjects and methods56 patients with metabolic syndrome (32 men/24 women, 40 non-diabetic patients (NDMetS)/16 diabetic patients (DMetS) [mean ± SD]: age: 50.35 ± 8.03 vs. 56.8 ± 9.30 years, p=0.023; baseline BMI: 32.2 ± 7.03 vs. 32.8 ± 5.94 kg/m2, p=0.739) were involved in our study. All tests and measurements were carried out before and following a 3-month physical training period. Autonomic function was assessed by means of five standard cardiovascular reflex tests. ECG repolarization parameters, including short-term QT variability and stress-ECG were also measured.ResultsIn the whole population, Valsalva-ratio (VR) and the autonomic score (AS) improved following training (VR: 1.49 ± 0.24 vs. 1.64 ± 0.34, p=0.001; AS: 2.05 ± 1.73 vs. 1.41 ± 1.36, p=0.015) accompanied by the significant decrease of the systolic (150.3 ± 16.12 vs. 134.1 ± 16.67 mmHg, p

BackgroundAutoimmune encephalitis (AE) is an increasingly recognized neuroinflammatory disease entity in which early detection and treatment leads to the best clinical outcomes. Movement disorders occur in AE but their characteristics are not well defined.ObjectivesTo identify the frequency, classification, and prognostic significance of movement disorders in AE.MethodsWe conducted a systematic review and random-effects meta-analysis of movement disorders in cell surface antibody mediated AE. The frequency of any movement disorder as well as the classification of movement disorders in AE serotypes was determined. We looked at adults 18 years and older and included publications that described at least 10 cases. We used the following four electronic databases: Medline (Ovid), EMBASE (Ovid), APA Psychinfo, and Cochrane library.ResultsA total of 1,192 titles and abstracts were reviewed. Thirty-seven studies were included in the final meta-analysis. At least one kind of movement disorder was present in 40% of the entire AE cohort, 53% with anti-NMDA receptor antibodies, 33% with anti-CASPR2 antibodies, 30% with anti-LGI1 antibodies and 13% with anti-GABA receptor antibodies. Dyskinesia was the commonest movement disorder in anti-NMDA antibody mediated AE and faciobrachial dystonic seizures were most frequent in anti-LGI1 antibody mediated AE. Patients with a movement disorder tended to have a higher mortality. The risk of bias in the included studies was mostly moderate or high.ConclusionMovement disorders are common in AE and their identification, in conjunction with other clinical and paraclinical features, may facilitate earlier diagnosis. The prognostic implications of movement disorders in AE warrant further dedicated study.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42023386920.

Neuropathy is a serious and frequent complication of type 2 diabetes (T2DM). This study was carried out to search for genetic factors associated with the development of diabetic neuropathy by whole exome sequencing. For this study, 24 patients with long-term type 2 diabetes with neuropathy and 24 without underwent detailed neurological assessment and whole exome sequencing. Cardiovascular autonomic function was evaluated by cardiovascular reflex tests. Heart rate variability was measured by the triangle index. Sensory nerve function was estimated by Neurometer and Medoc devices. Neuropathic symptoms were characterized by the neuropathy total symptom score (NTSS). Whole exome sequencing (WES) was performed on a Thermo Ion GeneStudio S5 system determining the coding sequences of approximately 32,000 genes comprising 50 million base pairs. Variants were detected by Ion Reporter software and annotated using ANNOVAR, integrating database information from dbSNP, ClinVar, gnomAD, and OMIM. Integrative genomics viewer (IGV) was used for visualization of the mapped reads. We have identified genetic variants that were significantly associated with increased (22–49-fold) risk of neuropathy (rs2032930 and rs2032931 of recQ-mediated genome instability protein 2 (RMI2) gene), rs604349 of myosin binding protein H like (MYBPHL) gene and with reduced (0.07–0.08-fold) risk (rs917778 of multivesicular body subunit 12B (MVB12B) and rs2234753 of retinoic acid X receptor alpha (RXRA) genes). The rs2032930 showed a significant correlation with current perception thresholds measured at 5 Hz and 250 Hz for n. medianus (p = 0.042 and p = 0.003, respectively) and at 5 Hz for n. peroneus (p = 0.037), as well as the deep breath test (p = 0.022) and the NTSS (p = 0.023). The rs2032931 was associated with current perception thresholds (p = 0.003 and p = 0.037, respectively), deep breath test (p = 0.022), and NTSS (p = 0.023). The rs604349 correlated with values measured at 2000 (p = 0.049), 250 (p = 0.018), and 5 Hz (p = 0.005) for n. medianus, as well as warm perception threshold measured by Medoc device (p = 0.042). The rs2234753 showed correlations with a current perception threshold measured at 2000 Hz for n. medianus (p = 0.020), deep breath test (p = 0.040), and NTSS (p = 0.003). There was a significant relationship between rs91778 and cold perception threshold (p = 0.013). In our study, genetic variants have been identified that may have an impact on the risk of neuropathy developing in type 2 diabetic patients. These results could open up new opportunities for early preventive measures and might provide targets for new drug developments in the future.

The past two decades have witnessed telemedicine becoming a crucial part of health care as a method to facilitate doctor-patient interaction. Due to technological developments and the incremental acquisition of experience in its use, telemedicine’s advantages and cost-effectiveness has led to it being recognised as specifically relevant to diabetology. However, the pandemic created new challenges for healthcare systems and the rate of development of digital services started to grow exponentially. It was soon discovered that COVID-19-infected patients with diabetes had an increased risk of both mortality and debilitating sequelae. In addition, it was observed that this higher risk could be attenuated primarily by maintaining optimal control of the patient’s glucose metabolism. As opportunities for actual physical doctor-patient visits became restricted, telemedicine provided the most convenient opportunity to communicate with patients and maintain delivery of care. The wide range of experiences of health care provision during the pandemic has led to the development of several excellent strategies regarding the applicability of telemedicine across the whole spectrum of diabetes care. The continuation of these strategies is likely to benefit clinical practice even after the pandemic crisis is over.