The Association of Longitudinal Serum Uric Acid and All-Cause Mortality in Incident Peritoneal Dialysis Patients

2018 ◽  
Vol 47 (1-3) ◽  
pp. 185-192 ◽  
Author(s):  
Wenxiu Chang ◽  
Wenyu Zhang ◽  
Xichao Wang ◽  
Ying Liu ◽  
Yingying Han ◽  
...  
Keyword(s):  
Uric Acid ◽  
Peritoneal Dialysis ◽  
Density Lipoprotein ◽  
Residual Renal Function ◽  
Reactive Protein ◽  
All Cause Mortality ◽  
Group 3 ◽  
Group 2 ◽  
Level Group ◽  
Group 1

Background: Time-averaged uric acid (TA-UA) value was calculated to investigate the association of longitudinal UA and all-cause mortality in incident peritoneal dialysis (PD) patients. Methods: Three hundred PD patients were divided into 3 groups based on the serum TA-UA level (Group 1: < 6 mg/dL; Group 2: 6–8 mg/dL; Group 3: ≥8 mg/dL). Hazards ratio (HR) of all-cause mortality was calculated. Logistic regression was conducted to identify the associated clinical factors of lower and higher TA-UA level. Results: Increased HRs for death existed in Group 1 and Group 3 compared with Group 2 (HR 3.24, 95% CI 1.25–8.39, p = 0.016; HR 4.69, 95% CI 1.24–17.72, p = 0.023). Lower residual renal function, lower albumin, and higher high-density lipoprotein cholesterol were related to the lower serum TA-UA. Higher body mass index and higher C-reactive protein were associated with higher serum TA-UA in PD patients. Conclusion: Both TA-UA < 6 and ≥8 mg/dL increased the all-cause mortality in incident PD patients.

The Relationship between Serum Ferritin Levels and 5-Year All-Cause Mortality in Hemodialysis Patients

2021 ◽  
pp. 1-7
Author(s):  
Emre Erdem ◽  
Ahmet Karatas ◽  
Tevfik Ecder
Keyword(s):  
Serum Ferritin ◽  
Hemodialysis Patients ◽  
Rank Test ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Group 3 ◽  
Group 2 ◽  
The Relationship ◽  
Group 1

<b><i>Introduction:</i></b> The effect of high serum ferritin levels on long-term mortality in hemodialysis patients is unknown. The relationship between serum ferritin levels and 5-year all-cause mortality in hemodialysis patients was investigated in this study. <b><i>Methods:</i></b> A total of 173 prevalent hemodialysis patients were included in this study. The patients were followed for up to 5 years and divided into 3 groups according to time-averaged serum ferritin levels (group 1: serum ferritin &#x3c;800 ng/mL, group 2: serum ferritin 800–1,500 ng/mL, and group 3: serum ferritin &#x3e;1,500 ng/mL). Along with the serum ferritin levels, other clinical and laboratory variables that may affect mortality were also included in the Cox proportional-hazards regression analysis. <b><i>Results:</i></b> Eighty-one (47%) patients died during the 5-year follow-up period. The median follow-up time was 38 (17.5–60) months. The 5-year survival rates of groups 1, 2, and 3 were 44, 64, and 27%, respectively. In group 3, the survival was lower than in groups 1 and 2 (log-rank test, <i>p</i> = 0.002). In group 1, the mortality was significantly lower than in group 3 (HR [95% CI]: 0.16 [0.05–0.49]; <i>p</i> = 0.001). In group 2, the mortality was also lower than in group 3 (HR [95% CI]: 0.32 [0.12–0.88]; <i>p</i> = 0.026). No significant difference in mortality between groups 1 and 2 was found (HR [95% CI]: 0.49 [0.23–1.04]; <i>p</i> = 0.063). <b><i>Conclusion:</i></b> Time-averaged serum ferritin levels &#x3e;1,500 ng/mL in hemodialysis patients are associated with an increased 5-year all-cause mortality risk.

Evaluation of clinical, endocrine and metabolic findings in obese children with and without hepatosteatosis

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Gunce Basarir ◽  
Bahar Ozcabi ◽  
Ozden Aksu Sayman ◽  
Hatice Ozturkmen Akay ◽  
Feyza M. Yildiz
Keyword(s):  
Uric Acid ◽  
Density Lipoprotein ◽  
Thyroid Stimulating Hormone ◽  
Fasting Insulin ◽  
Obese Children ◽  
Pubertal Stage ◽  
Alcoholic Fatty Liver ◽  
Group 2 ◽  
Group 1

Abstract Objectives Non-alcoholic fatty liver disease (NAFLD) is a common obesity-related comorbidity in childhood. In this study, we aimed to evaluate predictors of NAFLD by comparing clinical, endocrine and metabolic findings in obese children with and without hepatosteatosis. Methods Two hundred and eight obese children aged 6–18 years were included. The patients were divided into group 1 (patients with NAFLD, n=94) and group 2 (patients without NAFLD, n=114). Anthropometric measurements, pubertal stage, lipid profiles, fasting glucose and insulin, homeostatic model of assessment for insulin resistance (HOMA-IR), uric acid, total bilirubin, alanine aminotransferase (ALT), blood urea nitrogen, thyroid-stimulating hormone and free thyroxine parameters were compared retrospectively. Results The mean body weight, body mass index (BMI), height, tri-ponderal mass index (TMI), insulin, HOMA-IR, triglyceride, ALT and uric acid values were significantly higher, while high-density lipoprotein-cholesterol (HDL-C) values were significantly lower in group 1. The 70.7% of obese children with hepatosteatosis and 83.9% of those without hepatosteatosis were correctly estimated by parameters including age, gender, ALT, HDL-C, fasting insulin and uric acid values. Conclusions Since obesity-associated hepatosteatosis induces various long-term metabolic impacts in children, early detection is of critical importance. Age, gender, TMI, BMI, ALT, HDL-C, fasting insulin and uric acid values may help to predict the risk of hepatosteatosis. Besides, we assessed whether TMI compared to BMI does not have a better utility in estimating obesity-induced hepatosteatosis in children. This is the first study to show the association between TMI and hepatosteatosis in children.

Is Subjective Global Assessment a Good Index of Nutrition in Peritoneal Dialysis Patients with Gastrointestinal Symptoms?

2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 78-82 ◽  
Author(s):  
Yanjun Li ◽  
Jie Dong ◽  
Li Zuo
Keyword(s):  
Peritoneal Dialysis ◽  
Lean Body Mass ◽  
Body Mass ◽  
Global Assessment ◽  
Handgrip Strength ◽  
Subjective Global Assessment ◽  
Gi Symptoms ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective We investigated whether patients with gastrointestinal (GI) symptoms were prone to be diagnosed as malnourished by subjective global assessment (SGA) by simultaneously evaluating SGA and other indices of nutrition in a cross-sectional survey of peritoneal dialysis (PD) patients. Patients and Method From June 2006 to June 2007, 214 PD patients were involved in the study. We recorded results of a GI symptoms questionnaire (GSQ) and SGA. Other indices of nutrition included dietary intake, chemistry examination, anthropometry, handgrip strength, and lean body mass measured by creatinine kinetics. Results Mean age of the 214 PD patients enrolled in the study was 60.22 ± 14.02 years, and mean dialysis duration was 60.22 ± 14.02 months. Of the 214 patients, 56 (27.16%) were diagnosed as malnourished by SGA. The mean GSQ scores were 9.37 ± 1.71 (range: 8 – 17). There were 90 patients with GSQ scores of 8 (group 1), 80 patients with scores of 9 or 10 (group 2), 44 patients with scores of 11 or more (group 3). The prevalence of malnutrition diagnosed by SGA was significantly different in the three groups: 15.56% in group 1, 27.5% in group 2, and 45.45% in group 3 ( p = 0.02). However, we observed no difference between the three groups in mid-arm circumference, skinfold thickness (biceps, triceps, subscapular, and suprailiac), daily protein and energy intake, handgrip strength, lean body mass, and serum albumin and prealbumin levels ( p > 0.05). Conclusions Our results showed that the reliability of SGA in PD patients with GI symptoms remains worth exploring. These patients are possibly diagnosed as malnourished by SGA, although many other indices of nutrition are not necessarily bad.

scholarly journals Fever as a predictor of adverse outcomes in COVID-19

QJM ◽  
2021 ◽  
Author(s):  
N W Chew ◽  
J N Ngiam ◽  
S M Tham ◽  
Z Y Lim ◽  
T Y W Li ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Adverse Outcomes ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
End Point ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Design And Methods ◽  
Group 1

Summary Background/Introduction There are little data on outcomes of COVID-19 patients with the presence of fever compared to the presence of symptoms. Aim We examined the associations between symptomology, presence of fever and outcomes of a COVID-19 cohort. Design and Methods Between 23 January and 30 April 2020, 554 COVID-19 patients were admitted to a tertiary hospital in Singapore. They were allocated into four groups based on symptomology and fever—Group 1: asymptomatic and afebrile, Group 2: symptomatic but afebrile, Group 3: febrile but asymptomatic and Group 4: symptomatic and febrile. The primary outcomes were intensive care unit (ICU) admissions and mortality. The composite end-point included ICU admissions, mortality or any COVID-19 related end-organ involvement. Results There were differences in ferritin (P=0.003), C-reactive protein (CRP) levels (P&lt;0.001) and lymphopenia (P=0.033) across all groups, with the most favourable biochemical profile in Group 1, and the least in Group 4. Symptomatic groups (Groups 2 and 4) had higher ICU admissions (1.9% and 6.0%, respectively, P=0.003) than asymptomatic groups (Groups 1 and 3). Composite end-point was highest in Group 4 (24.0%), followed by Group 3 (8.6%), Group 2 (4.8%) and Group 1 (2.4%) (P&lt;0.001). The presence of fever (OR 4.096, 95% CI 1.737–9.656, P=0.001) was associated with the composite end-point after adjusting for age, pulse rate, comorbidities, lymphocyte, ferritin and CRP. Presence of symptoms was not associated with the composite end-point. Discussion/Conclusion In this COVID-19 cohort, presence of fever was a predictor of adverse outcomes. This has implications on the management of febrile but asymptomatic COVID-19 patients.

scholarly journals The target matters – general vs. individualized exercise prescription for fertile-aged women with metabolic risk: a randomized controlled trial

2020 ◽  
Author(s):  
Maritta K Poyhonen-Alho ◽  
Vesa Hyrylä ◽  
Mika P. Tarvainen ◽  
Heikki O. Tikkanen ◽  
Saila Koivusalo ◽  
...  
Keyword(s):  
Body Composition ◽  
Gestational Diabetes ◽  
Oxygen Uptake ◽  
Exercise Intervention ◽  
Density Lipoprotein ◽  
Individualized Intervention ◽  
Randomized Controlled ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Little is known about the associations of different depths of individualization of the exercise intervention on cardiorespiratory fitness (CRF), metabolic outcomes and cardiac autonomic regulation in at-risk subjects. This randomized trial compared the effect of general physical activity (PA) guideline -targeted and highly individualized exercise intervention on maximal oxygen uptake, heart rate variability, body composition, and glucose and lipid profiles in fertile-aged women with increased risk for gestational diabetes. Methods Forty-five women with previous gestational diabetes or BMI>30kg/m 2 were randomized into general advice without intervention (Group 1), individualized intervention planned according to PA questionnaires and general guidelines for exercise training (Group 2) and highly individualized intervention based on results from the pre-intervention cardiopulmonary exercise test (CPET) groups (Group 3). All subjects performed pre-intervention CPET on a cycle ergometer with step incremental protocol until volitional fatigue, followed by a 3-month intervention period and post-intervention CPET. Examinations included HRV assessment during CPET and body composition (bioimpedance), blood glucose and lipid profiles. Results Total dropout was 53.8% at various points of the study leaving 8 subjects in Group 1, 12 subjects in Group 2 and 10 subjects in Group 3. CRF improved only in Group 3 (+1.9 ml/kg/min, 95% CI 0.3 to 3.5). This was associated with an increase in high-density lipoprotein (0.18 mmol/L, 95% CI 0.04 to 0.32) and increased HRV. In Group 2, we found a decrease in body mass index (-0.7 kg/m 2, 95% CI -1.3 to -0.1), fasting insulin (-4.14 mU/L, 95% CI -6.58 to -1.70), insulin resistance (-1.21, 95% CI -1.88 to -0.54), and low-density lipoprotein (-0.44 mmol/L, 95% CI -0.79 to -0.09). The dropouts in Group 1 had significantly less weight, smaller waist circumference, less visceral fat, and higher maximal oxygen uptake compared to the continuers in Group 1. Conclusions To improve CRF and cardiac autonomic function the exercise intervention should be highly individualized. PA intervention focused to achieve general exercise guidelines is not enough to improve CRF over 3-month period but combined with weight loss has beneficial effects on the metabolic profile. In randomized controlled trials, dropout may be biased. Trial Registration clinicaltrials.gov (NCT01675271)

scholarly journals Association of Haemoglobin and C-Reactive Protein level with Different Risk Factors among Acute Coronary Syndrome Patients

2019 ◽  
Vol 5 (2) ◽  
pp. 156-160
Author(s):  
Md Mahboob Morshed ◽  
Md Joynul Islam ◽  
ATM Ashadullah ◽  
Khondker Shaheed Hussain ◽  
Mohammad Ahtashamul Haque
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Reactive Protein ◽  
Coronary Syndrome ◽  
Group 4 ◽  
History Of ◽  
Study Population ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Different risk factors may be related with the haemoglobin and CRP level among the acute coronary syndrome patients. Objective: The purpose of the present study was to see the association of haemoglobin and CRP level with different type of risk factors among the acute coronary syndrome patients. Methodology: This cross-sectional study was conducted in the Department of Cardiology at Mymensingh Medical College, Mymensingh, Bangladesh from December 2010 to November 2011 for a period of two (02) years. Patients of ACS who were presented within 12 hours of chest pain were included as study population. Study population were categorized in four groups according to the level of hemoglobin and C-reactive protein. Age, cardiovascular risks factor, history, family history of cardiovascular disease, treatment history and ECG were taken during admission. Blood sample was collected for baseline laboratory investigations like Troponin-I, Random Blood Sugar (RBS), Blood urea, Serum creatinine, lipid profile, Hemoglobin & CRP level. Sample were then send to standard laboratory/Biochemistry department of MMCH. Result: The mean age of the population was 52.18±8.88 years. Smoking was the highest percentage in Group 1 which was 54(50.0%) cases (P=0.001). Hypertension was found most common in group 1 (47.6%), Group 2 (33.3%), Group 3 (10.7%) and Group 4 (8.3%). Smoking (p=0.001) and hypertension (p=0.016) was found statistically significant. Diabetes was found in Group 1 (37.7%), Group 2 (43.5%), Group 3 (11.6%) and Group 4 (7.2%). Group 1 (50%) and Group 2 (50%) patients were dyslipidaemic. Family history of IHD was present group-1 (36.8%), Group 2 (44.7%), Group 3 (73.2%) and Group 4 (53%). Among the smoker patient 65.6% cases had CRP level ˃12 mg/l; 39.8% cases had CRP level ˂12mg/L. Among the nonsmoker 34.4% cases had CRP level ˃12mg/l and 60.2% cases had CRP level ˂12mg/L. The finding was statistically significant. Conclusion: In conclusion haemoglobin and CRP level is associated with different type of risk factors among the acute coronary syndrome patients. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 156-160

Evaluation of the New Classification and Surgical Strategy for Myasthenia Gravis

2012 ◽  
Vol 78 (12) ◽  
pp. 1329-1335 ◽  
Author(s):  
Xin-Zheng Cui ◽  
Xin-Ying Ji ◽  
Feng Gao ◽  
Kun-Peng Yang ◽  
Hui-Ling Bai ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
New Classification ◽  
New Methods ◽  
Group 3 ◽  
Group 2 ◽  
Level Group ◽  
Median Incision ◽  
Selection Of ◽  
Made In ◽  
Group 1

The aim of this study was to discuss the new methods of clinical classification and staging of patients with myasthenia gravis (MG) proposed by our group and to summarize the experiences of surgical treatment of MG with a novel incision by cutting the sternum cross-sectionally at the second intercostal level. A retrospective analysis was made for the clinical data from the patients with MG who underwent thymectomy from July 1988 to May 2009. The surgical procedures were designed into three groups, a group with Osserman classification and median incision of the sternum (Group 1), a group with MGFA typing (Myasthenia Gravis Foundation of America) and a small transverse sternal incision at the second intercostal level (Group 2), and a group with new typing and a smaller transverse sternal incision at the second intercostal level (Group 3). Observation of the clinical typing and staging was made in the patients with myasthenia crisis. The parameters such as procedure duration in Group 2 and 3 was significantly lower than those in Group 1 ( P < 0.05). The incidence of myasthenia crisis in Group 3 was significantly lower than that in Groups 2 and 3 ( P < 0.05). The procedure with a smaller transverse sternal incision at the second intercostal level (Group 3) is a safer method for patients with MG. The combination of this procedure with the new typing and staging methods proposed by our group could facilitate the selection of operation indications and opportunity, resulting in the lower incidence of myasthenia crisis and mortality. Our new procedure is well deserved to be a preferential selection by other hospitals.

Castleman disease spectrum.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 8548-8548
Author(s):  
Johnson Khor ◽  
Sheila K. Pierson ◽  
Victoria Powers ◽  
Mark-Avery Tamakloe ◽  
Alexander Gorzewski ◽  
...  
Keyword(s):  
Disease Activity ◽  
Disease Severity ◽  
Castleman Disease ◽  
Positive Correlation ◽  
Reactive Protein ◽  
Disease Spectrum ◽  
Diagnostic Values ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

8548 Background: Castleman disease (CD) describes a group of lymphoproliferative disorders that share characteristic histopathology. Unicentric CD (UCD) and idiopathic multicentric CD (iMCD) are differentiated by the number of enlarged lymph node (LN) regions: UCD involves 1 region and iMCD involves > 1 region. UCD typically has mild or no symptoms whereas iMCD requires abnormal labs and symptoms for diagnosis and can progress to life-threatening multi-organ failure. Review of an international natural history registry of CD revealed patients across a broad spectrum with regards to number of enlarged LN regions and disease severity. We hypothesize that there is a positive correlation between disease activity and the number of enlarged LNs and that the spectrum of CD is more complex than a binary UCD-iMCD dichotomy. Methods: Herein, enrolled UCD and iMCD patients whose diagnosis was confirmed by an expert-panel were selected for analysis (N = 81). A standardized disease activity score (scale 0-1) was computed for each patient using available diagnostic values of C-reactive protein, hemoglobin, and albumin (CHA score). Results: We looked at the association between number of enlarged LNs and CHA and found a significant positive correlation (R = 0.65, p < 0.0001). Given this, we divided the cohort into groups of mild, moderate, and extensive lymphadenopathy according to the number of regions of enlarged LNs at the time of diagnosis: group 1 (1 enlarged LN region); group 2 (2-4 enlarged LN regions); and group 3 (≥5 enlarged LN regions). We identified 20 patients in group 1, 19 in group 2, and 42 in group 3 with no statistical differences in sex, race, or age at diagnosis. Histopathological subtype differed significantly among groups. Group 1 was 89% hyaline vascular (HV)/ hypervascular (HpV) and 11% mixed (Mx); group 2 was 74% HV/HpV, 21% Mx, and 5% plasmacytic (Pl); and group 3 was 64% HV/HpV, 32% Mx, and 5% Pl. We then looked at CHA score in these groups and found that group 3 patients have a significantly greater CHA score (median [IQR]: 0.46 [0.49]) than both group 2 (0.08 [0.14]) and group 1 (0.0 [0.10]) (adjusted p < 0.001 for both) while there was no difference between groups 1 and 2. Conclusions: These results suggest that disease severity is positively associated with the number of enlarged LNs. The different proportions of histopathological subtypes between the three groups could indicate different pathologic mechanisms are involved. Further work is needed to determine if patients with a few enlarged LNs exhibit disease more closely to UCD or iMCD and to understand long-term outcomes for these patients.

The relationship between uric acid to high-density lipoprotein cholesterol ratio and collateral index in patients with chronic total occlusion

Kardiologiia ◽  
2021 ◽  
Vol 61 (9) ◽  
pp. 61-65
Author(s):  
Cihan Aydın ◽  
Nadir Emlek
Keyword(s):  
Uric Acid ◽  
High Density Lipoprotein ◽  
High Density Lipoprotein Cholesterol ◽  
Collateral Circulation ◽  
Density Lipoprotein ◽  
High Density ◽  
Lipoprotein Cholesterol ◽  
Total Occlusion ◽  
Group 2 ◽  
Group 1

Background    High serum uric acid (UA) levels and low high-density lipoprotein cholesterol (HDL–C) levels are accepted as risk factors for cardiovascular mortality. Hyperuricemia and low HDL–C levels were associated with an increased risk of cardiovascular mortality and the development of diabetes and hypertension. However, the association of UA with cardiovascular (CV) mortality,collateral index are undetermined in patients with chronic total occlusion (CTO).Material and methods    124 patients who underwent coronary angiography with the diagnosis of stable or unstable angina pectoris and had chronic total occlusion were included in our study. Blood samples were collected from all patients before the angiography procedure. Coronary collateral circulation (CCC) was graded according to the Rentrop grading system of 0–3. Rentrop grades of 0 and 1 indicated low-grade CCC group, whereas grades 2 and 3 indicated high-grade CCC group. We divided our patients into two groups as low-grade CCC and high-grade CCC and examined these two groups in terms of uric acid / HDL ratios. Group 1: Rentrop classification grade 0–1 (mean age, 63,9±9,9), Group 2: Rentrop classification grade 2–3 (mean age, 62,1±9,4).Results    The baseline characteristics were similar in both groups. Uric acid / High density lipoprotein-cholesterol ratios and uric acid levels were higher in group 1 with poor collateral circulation [group 1; 0,21 (0,07–0,39) vs. group 2; 0,16 (0,08–0,31), group 1; 8,2 (3,4–10,4) vs. group 2; 5,85 (3,5–7,7), p<0,001, p<0,001 respectively].Conclusions    We found that high Uric acid / High-density lipoprotein-cholesterol ratios and high uric acid levels are associated with poor collateral circulation.

scholarly journals The generation of visual inferences in normal elderly Influence of schooling and visual complexity

2010 ◽  
Vol 4 (3) ◽  
pp. 194-201 ◽  
Author(s):  
Ariella Fornachari Ribeiro ◽  
Maria Isabel d'Ávila Freitas ◽  
Márcia Radanovic ◽  
Letícia Lessa Mansur
Keyword(s):  
Visual Complexity ◽  
The Other ◽  
Elderly Subjects ◽  
Healthy Elderly ◽  
Group 3 ◽  
Group 2 ◽  
Level Group ◽  
Different Levels ◽  
Healthy Elderly Subjects ◽  
Group 1

Abstract The generation of inferences makes the construction and comprehension of discourse easier, and integrates representations which add coherence to the arguments. Visuoperceptual and inferential deficits merge in the attempt to explain the difficulties that some individuals have in the comprehension of certain kinds of visual stimuli. Objectives: a) To examine the performance of cognitively healthy elderly subjects in the execution of visual inferences using pictures of different levels of complexity; b) To compare the performance of subjects according to schooling level. Methods: A total of 45 normal elderly aged from 61 to 82yrs (M=68; SD=0.57) were examined. The subjects were divided into three groups according to schooling level: Group 1 (1 to 4 years); Group 2 (5 to 8 years) and Group 3 (9 or more years). Each subject had to create a narrative based on four figures with controlled visual complexity. The narratives were transcribed, analysed and scored. Results: For the essential inferences, the high educated group (3) had a better performance in both visually simple and complex conditions. On the visually complex figures, the medium educated group (2) was statistically equivalent to the high educated group for one figure and equivalent to the less educated group (1) for the other. There was no difference among the groups for the accessory propositions. Conclusions: Visual complexity interferes with the subject's ability to make inferences in low and medium educated individuals. High educated subjects maintain the same performance in making inferences, regardless of the visual complexity level.

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