Mitchell Hanson

The objective of this randomized controlled trial was to evaluate the impact of a multifactorial exercise program on circulating inflammation in people living with dementia (PWD) in residential care. This parallel-group, 6-month assessor-blinded trial (NCT05488951) allocated (1:1) 42 PWD to a multifactorial exercise intervention or usual care alone in residential care settings between July 2022 and January 2023. The exercise group engaged in 30 min of physical therapist-led strength and balance training, followed by 30 min of walking 3 x/week over 6 months, and received usual care. The usual care group only received care from healthcare providers, ongoing medical treatment, and opportunities to participate in social activities. Fasted blood was drawn at baseline and 6 months. Intention-to-treat (ITT) and per-protocol (PP; ≥2 x/week exercise vs. usual care) analyses were conducted. The ITT analysis revealed no differences between groups over time (p > 0.05). In adjusted PP analyses, there was a group-by-time interaction trend resulting in decreases in IL-1β (−3.6; +5.0 pg/mL) and IL-8 (−13.4; +14.0 pg/mL) in the exercise group compared with usual care (IL-1β: p = 0.089; IL-8: p = 0.087). Findings suggest adherence-dependent reductions in pro-inflammatory cytokines, indicating potential benefits of exercise. However, this trial was not powered for this secondary analysis, necessitating the need for larger, adequately powered trials.

Background: Physiological changes, including metabolic and cellular aging, as well as increased inflammation, occur in people living with dementia (PWD). While there is existing evidence in other populations suggesting that exercise may improve physiological outcomes, their impact in PWD remains unclear. This randomized controlled trial (RCT) aimed to assess the effects of exercise on serum levels of metabolic aging, cellular aging, and inflammatory blood biomarkers relative to usual care alone in PWD.Method: This pilot RCT involved n=42 PWD (exercise n=21; usual care n=21) in one nursing home and one assisted living facility (NCT05488951). The adapted Otago Exercise Program involved 30 minutes of tailored lower body strength and balance exercises and 30 minutes of walking 3x/week for 6 months. We drew fasted blood at baseline and 6 months. Blood samples were stored at ‐80°F and analyzed for metabolic aging (kynurenine), cellular aging (telomere length), and inflammatory biomarkers (interleukin‐6, IL‐1b, interferon alpha2, IFNg, tumor necrosis factor a, chemokine ligand 2, IL‐8, IL‐10, IL‐12p70, IL‐17A, IL‐18, IL‐23, IL‐33). Generalized mixed models were used for intent‐to‐treat (n=42) and per protocol analyses (usual care: n=21; n=9 exercisers with ≥2/3 adherence), controlling for age, race, sex, and the Montreal Cognitive Assessment.Result: The intent‐to‐treat analysis revealed no differences in physiological biomarkers between groups. The per protocol analysis revealed a trend for reduced inflammation in IL‐1b (exercise: 9.73 to 6.16 pg/mL; usual care:10.51 to 15.46 pg/mL; p=0.09) and IL‐8 (exercise: 39.34 to 25.92 pg/mL; usual care:78.99 to 93.04 pg/mL; p=0.09). Additionally, the control group increased telomere length compared to the exercise group (exercise:8.0 to 7.9 kb; usual care:7.9 to 8.7 kb; p=0.01).Conclusions: The trend for exercise reducing inflammation in the per protocol analysis suggests that a greater amount of exercise (i.e., ≥2/3 exercise adherence) may be necessary to reduce inflammation in PWD. The nuanced relationship between exercise reducing cellular aging in the usual care group requires further exploration, as we had a small sample size in our per protocol analysis. Our pilot findings may inform a larger RCT to determine a potential interplay between exercise and physiological biomarkers in PWD.

Erythema nodosum (EN) is inflammation of subcutaneous fat. Etiologies include autoimmune diseases, drugs, infections, pregnancy, malignancy, and idiopathic origins. A 37-year-old female with a history of recurrent cellulitis and type II diabetes presented with worsening swollen lumps on upper extremities for four months during a Hurley Stage III hidradenitis suppurativa (HS) flare. Exam revealed multiple erythematous pustules and warm indurated nodules over diffuse edema on the upper extremities. Lesions were refractory to trimethoprim/sulfamethoxazole, cefalexin, clindamycin, and levofloxacin. Routine blood labs, ESR, and ANA were unremarkable. EN was diagnosed. Trimethoprim/sulfamethoxazole, saturated solution potassium iodide (SSKI), and ibuprofen were prescribed. At the three-week follow-up, EN completely resolved the issue except for one lesion. Literature review revealed one case of EN manifestation in association with HS but was complicated by Beçhet’s syndrome. We propose HS as an underlying cause of EN and SSKI an effective treatment for EN and HS.

Vitiligo is an autoimmune condition that causes patchy skin depigmentation. Although the mechanism by which vitiligo induces immunocompromise is unclear, other related autoimmune diseases are known to predispose those affected to infection. Individuals with vitiligo exhibit epidermal barrier disruption, which could potentially increase their susceptibility to systemic infections; patients with renal disease also show a predisposition to infection. Nevertheless, there is little research addressing the risk of infection in dialysis patients with vitiligo in comparison to those without it. A retrospective analysis was performed on patients with end-stage renal disease (ESRD) in the United States Renal Data System who started dialysis between 2004 and 2019 to determine if ESRD patients with vitiligo are at an increased risk of bacteremia, cellulitis, conjunctivitis, herpes zoster, or septicemia. Multivariable logistic regression modeling indicated that female sex, black compared to white race, Hispanic ethnicity, hepatitis C infection, and tobacco use were associated with an enhanced risk of vitiligo, whereas increasing age and catheter, versus arteriovenous fistula, and access type were associated with a decreased risk. After controlling for demographics and clinical covariates, vitiligo was found to be significantly associated with an increased risk of bacteremia, cellulitis, and herpes zoster but not with conjunctivitis and septicemia.

Facial emotion recognition is a vast and complex problem space within the domain of computer vision and thus requires a universally accepted baseline method with which to evaluate proposed models. While test datasets have served this purpose in the academic sphere real world application and testing of such models lacks any real comparison. Therefore we propose a framework in which models developed for FER can be compared and contrasted against one another in a constant standardized fashion. A lightweight convolutional neural network is trained on the AffectNet dataset a large variable dataset for facial emotion recognition and a web application is developed and deployed with our proposed framework as a proof of concept. The CNN is embedded into our application and is capable of instant real time facial emotion recognition. When tested on the AffectNet test set this model achieves high accuracy for emotion classification of eight different emotions. Using our framework the validity of this model and others can be properly tested by evaluating a model efficacy not only based on its accuracy on a sample test dataset, but also on in the wild experiments. Additionally, our application is built with the ability to save and store any image captured or uploaded to it for emotion recognition, allowing for the curation of more quality and diverse facial emotion recognition datasets.