5th Decade Research Articles

Prediction of Pathological Risk Stratification using Computed Tomography Features in Gastrointestinal Stromal Tumours: A Retrospective observational Study

Introduction: Gastrointestinal Stromal Tumours (GISTs) are the most common mesenchymal tumours of gastrointestinal tract. A high postsurgical recurrence and metastatic rate have created a need for a presurgical risk profile identification system. Aim: To assess the association between morphological Computed Tomography (CT) parameters with the pathological risk profile and analyse which CT features can predict the risk grading of GISTs. Materials and Methods: This was a retrospective cohort study based on imaging and histopathological data of 26 patients with pathologically proven GISTs presenting to the Department of Radiodiagnosis of a tertiary hospital in the northern Indian Himalayan foothills over a period of five years from July 2018 to June 2023. CT imaging features including size, growth pattern, margins, enhancement, calcifications, necrosis, intralesional haemorrhage, enlarged feeding vessels, direct organ invasion, and associations such as ascites and lymphadenopathy were studied. All lesions were classified as per Miettinen risk classification into no risk, very low-risk, low, moderate, and high-risk lesions. Analysis was done by the Chi-square test. Predictive analysis was carried out by computing the odds ratio and performing regression analysis on significantly associated imaging features. Results: Out of 26 patients, the study group comprised 16 males (61.54%) and 10 females (38.46%). The most common decade of presentation was the 6th decade with the mean age of presentation being 55.81±4.23 years. Twelve patients were grouped under intermediate to high-risk grading. Lesion size >5 cm (p-value=0.0171, OR=19.12), ill-defined margins (p-value=0.0048, OR=18.33), intralesional necrosis (p-value=0.0053, OR=19.8), and enlarged feeding vessels (p-value=0.012, OR=21.27) were identified as imaging features with significant association and predictive ability for high-risk lesions. The strongest predictive ability for a high-risk profile was shown by ill-defined margins (R2 =0.381) and intralesional necrosis (R2 =0.3287). Conclusion: A preoperative Contrast Enhanced Computed Tomography (CECT) assessment provides a comprehensive imaging profile for GISTs as well as a fair accuracy of risk profile prediction via various singular and clustered morphological parameters.

Nerve Sheath Tumours In and Around Spine—A Series of 50 Cases

Abstract Background: Nerve sheath tumours in and around the spine, especially in the junctional zones, are a challenging endeavour for the surgeon, because of the difficulty in approaching these structures as well as their close proximity to the major vessels and nerves. Most of these tumours are benign in nature. They are usually very slow growing, and hence the tumour may be detected very late in its clinical course unless it compresses or encircles any of the major neurovascular structures early in its course. The surgical results after the excision of these tumours are excellent. Most of the patients get completely cured by prompt treatment. Here we present a series of 50 nerve sheath tumours in and around the spine operated over a period of 21 years. Materials and Methods: A retrospective study was done for 50 patients who underwent an operation for nerve sheath tumours in and around the spine, over a period of 21 years. Patient’s clinical and radiological data were extracted from the Medical Record Department (MRD) of our hospital and analysed. Results: Out of the 50 cases of nerve sheath tumours, 40 patients (80%) were of schwannoma and 10 patients (20%) were of neurofibroma. Overall, 10 patients had dumbbell tumours (neurofibroma+schwannoma). The mean age group was between 4th and 6th decade. Patients were followed up for a minimum of 1 year and a maximum of 20 years period. All of these tumours were benign except one patient who had a malignant neurofibroma of the C-8 nerve root. 15 out of 50 patients presented with paraparesis, 5 with paraplegia and another 5 with quadriparesis. All these patients had complete neurological recovery after surgical removal of the tumours. Conclusion: This case series brings out the nuances in the management of nerve sheath tumours in and around the spine and their results.

Cardiometabolic diseases and associated risk factors in transitional rural communities in tropical coastal Ecuador.

There is a growing epidemic of chronic non-communicable diseases in low and middle-income countries, often attributed to urbanization, although there are limited data from marginalized rural populations. This study aimed to estimate prevalence of cardiometabolic diseases and associated risk factors in transitional rural communities. A cross-sectional study of Montubio adults aged 18-94 years living in agricultural communities in a tropical coastal region of Ecuador. Data were collected by questionnaires and anthropometry, and fasting blood was analyzed for glucose, glycosylated hemoglobin, insulin, and lipid profiles. Population-weighted prevalences of diabetes, hypertension, and metabolic syndrome were estimated. Associations between potential risk factors and outcomes were estimated using multilevel regression techniques adjusted for age and sex. Out of 1,010 adults recruited, 931 were included in the analysis. Weighted prevalences were estimated for diabetes (20.4%, 95% CI 18.3-22.5%), hypertension (35.6%, 95% CI 29.0-42.1%), and metabolic syndrome (54.2%. 95% CI 47.0-61.5%) with higher prevalence observed in women. Hypertension prevalence increased with age while diabetes and metabolic syndrome peaked in the 6th and 7th decades of life, declining thereafter. Adiposity indicators were associated with diabetes, hypertension, and metabolic syndrome. We observed an unexpectedly high prevalence of diabetes, hypertension, and metabolic syndrome in these marginalized agricultural communities. Transitional rural communities are increasingly vulnerable to the development of cardiometabolic risk factors and diseases. There is a need for targeted primary health strategies to reduce the burden of premature disability and death in these communities.

Occurrence of bisphosphonate-associated osteonecrosis of the jaws in individuals with rheumatoid arthritis - a systematic review.

To access the occurrence of bisphosphonate-associated osteonecrosis of the jaw (BAONJ) in individuals with rheumatoid arthritis (RA). Observational studies that evaluated the occurrence of BAONJ in individuals with RA (BAONJ-RA) were considered for inclusion. Electronic searches were performed up to December 2022 in six databases and in the grey literature. The study selection, data extraction, and quality assessment of the included studies according to the Joanna Briggs Institute Critical Appraisal Checklists was performed. The certainty of evidence was evaluated using the GRADE approach. Five studies were included three cohort and two cross-sectional. The sample size of subjects with RA ranged from 16 to 3201. Together, the studies presented 36 cases of BAONJ-RA. Prevalence of BAONJ-RA ranged from 0.094% to 56.25%. The incidence ranged from 0.4% to 2.21. Women between the 6th and 8th decade of life were the most affected. Alendronate (n=5) and zoledronic acid (n=9), orally and intravenously, respectively, were the most used bisphosphonates. The duration of bisphosphonates use ranged from 2.7 to 8 years. The certainty of evidence was very low. The occurrence of BAONJ-RA is low. However, the certainty of the evidence was very low for this outcome.

A study on the relation between preoperative serum albumin levels and postoperative outcome in emergency abdominal surgeries

Background: Nutritional evaluation is critical for identifying patients who are at risk of developing postoperative complications as a result of severe malnutrition. One of the routinely used markers to assess nutritional status is serum albumin. Aims and Objectives: The aim of the study is to evaluate the relationship between preoperative serum albumin levels and postoperative outcomes in emergency abdominal surgeries. Materials and Methods: This prospective analytical observational study was conducted on 50 patients who underwent major emergency abdominal surgeries under the department of general surgery in Dr. PSIMS and RF from January 2021 to January 2023. Results: In our study majority of the cases were in the 4th and 5th decade of life. 73.33% of the patients were male and 26.66% were female. Preoperative mean serum albumin level in males was 3.22 ± 0.54 mg/dl and 3.41 ± 0.32 mg/dl in females. The rate of postoperative complication was nearly similar in both groups, that is, 14 male patients (36.36%) and 4 female patients (37.50%). The 30-day mortality rate was strongly linked (P = 0.001) to lower serum albumin levels (<3.2 gm/dl). Conclusion: Serum albumin is an excellent prognostic predictor due to its capacity to detect PEM, which is not always linked with reduced body weight and may not be clinically recognized, but is associated with a considerable increase in morbidity. Serum albumin level below the threshold of 3.2 g/dl was found to be a major determinant of subsequent squeal as well as mortality in the postoperative period.

Nosocomial infections in patients admitted in medical intensive care units in a tertiary health center in Western part of India and their hematological correlation

Background and Aim: Acquired infections (AIs) in medical intensive care units (MICUs) have become serious threats with increasing mortality and morbidity more so in the developing countries. The most common reason is lack of efficient infection control protocols. The national nosocomial infections surveillance system defines a nosocomial infection as a localized or systemic condition that results from adverse reaction to the presence of infectious agents or their toxins that were not present or incubating at the time of admission to the hospital. Critically ill patients are at increased risk of acquiring nosocomial infections because of their lower immune status. These infections being opportunistic, microbes of low virulence cause also cause disease in hospital patients whose immune systems are impaired. This study was conducted to study the association of leukocytosis in relation to nosocomial infections in MICU. Methods: A retrospective study was conducted at the MICU under the Department of Anesthesiology in collaboration with the Department of Microbiology and Department of Pathology of Mahatma Gandhi Medical College and Hospital, Navi Mumbai over six months. All the patients who were admitted in MICU and stayed for more than 48 hours were included in the present study. Results: A total of 805 patients were admitted in the MICU from January 1st to June 30th, 2017, for a period of 6 months. Out of 805 cases, 27 patients developed nosocomial infections amounting to 3.3% with male-to-female ratio of 2.8:1. The age of the patient ranged from 15 to 85 years with the mean age of 50 years. Male predominance was seen with 74% cases with mean age of 48.5 years. Maximum cases were seen in the geriatric age group mainly 6th to 7th decade comprising of 40.7% of all cases. In our study, bloodstream infection was the most common finding constituting 100% of the cases, followed by urinary tract infections. All the cases of nosocomial infections showed polymorphonuclear leukocytosis with shift to left. In our study, diabetes mellitus followed by hypertension and chronic kidney disease was the major contributory comorbidities comprising of 29.6%, 29.6%, and 22.2%, respectively. In our study, the invasive devices contributed to the overall outcome of the patients. Urinary catheters (all cases) were the most prevalent invasive device followed closely by Ryle’s tube (90%) and endotracheal tube (60%). Conclusions: Intensive care units (ICUs) comprise of less than 10% of the total hospital beds but contribute >20% of all the nosocomial infections acquired in the hospital. World Health Organization (WHO) estimates the burden of nosocomial infections in hospitalized patients to be 7–12% globally, in contrast to the figures from India being alarmingly high varying from 11–83%.

The Interfascicular Matrix of Energy Storing Tendons Houses Heterogenous Cell Populations Disproportionately Affected by Aging.

Energy storing tendons such as the human Achilles and equine superficial digital flexor tendon (SDFT) are prone to injury, with incidence increasing with aging, peaking in the 5th decade of life in the human Achilles tendon. The interfascicular matrix (IFM), which binds tendon fascicles, plays a key role in energy storing tendon mechanics, and aging alterations to the IFM negatively impact tendon function. While the mechanical role of the IFM in tendon function is well-established, the biological role of IFM-resident cell populations remains to be elucidated. Therefore, the aim of this study was to identify IFM-resident cell populations and establish how these populations are affected by aging. Cells from young and old SDFTs were subjected to single cell RNA-sequencing, and immunolabelling for markers of each resulting population used to localise cell clusters. Eleven cell clusters were identified, including tenocytes, endothelial cells, mural cells, and immune cells. One tenocyte cluster localised to the fascicular matrix, whereas nine clusters localised to the IFM. Interfascicular tenocytes and mural cells were preferentially affected by aging, with differential expression of genes related to senescence, dysregulated proteostasis and inflammation. This is the first study to establish heterogeneity in IFM cell populations, and to identify age-related alterations specific to IFM-localised cells.

Retrospective Analysis of Histopathological Reports of Salivary Gland Pleomorphic Adenomas in Tanzania.

Pleomorphic adenoma (PA) is the most common benign tumor representing about 80% of all salivary gland tumors. Despite this, there is limited documentation of the demographic information and pattern of PA in Tanzania. This study retrospectively determines the demographic information and the pattern of presentation of pleomorphic adenomas of the salivary gland among patients managed at a tertiary hospital in Tanzania. This was a retrospective study of histological results of salivary gland pleomorphic adenoma diagnosed between 2016 and 2021. The information gathered included the age and sex of the patient and the anatomical location. Data analysis was done using Statistical Package for the Social Sciences version 27 computer program. Out of 1824 reports of patients with oral and maxillofacial lesions retrieved from the archives of the department, 62 (3.4%) had the diagnosis of pleomorphic adenoma of the salivary glands. The patients' ages at diagnosis ranged from 7 to 72 years, with a mean age of 39.9 (SEM = 2.3) years. The male-to-female ratio of patients diagnosed with pleomorphic adenoma was 1:1. There were 31 (50%) cases of pleomorphic adenomas affecting major salivary glands. The palatal minor salivary glands were the most (n=31, 50%) affected followed by the parotid gland (n=16, 25.8%). Pleomorphic adenomas have no sex predilection, most of these lesions occur during the 3rd to 5th decade of life. The majority of pleomorphic adenomas occur in the palatal minor salivary glands.

Recurrent Transient Ischemic Attack in the Elderly due to Asymptomatic Atrial Septal Defect: An Unusual Scenario

Atrial septal defects (ASD) are congenital cardiac anomalies, characterized by abnormal communication between the atria. These are commonly diagnosed in childhood and occasionally remain asymptomatic and undetected until the later stages of life. In ASD, there is communication between atria. Until the 4th decade of life, the majority of ASD are asymptomatic. Some exhibit the signs of exhaustion, syncope, exercise intolerance, and dyspnea with effort. Eisenmenger syndrome, paradoxical embolism, and atrial arrhythmias are among the problems that some people may later on develop. We describe a particular case of a 70-year-old male who arrived with a transient ischemic attack where he had left-sided upper limb weakness due to a paradoxical embolism due to ASD.

Pulmonary Alveolar Proteinosis in a Three-month-old Infant: An Unusual Case Report

Pulmonary Alveolar Proteinosis (PAP) is an unusual diffuse lung disease characterised by the alveolar accumulation of phospholipoprotein material, with a peak incidence in the 3rd to 4th decades of life and a male predominance. However, it has also been described in children. The recorded prevalence is 0.1 per 100,000 individuals. The major clinicopathogenetic subtypes include the autoimmune (idiopathic) form, which is associated with Granulocyte-macrophage Colony-stimulating Factor (GM-CSF) autoantibodies, the secondary form and the congenital form (associated with surfactant gene mutations). Common presenting features include dyspnoea, cough, low-grade fever, inspiratory crackles and digital clubbing. Pulmonary function tests typically show restrictive ventilatory defects. Herein, the authors present a case of a three-month-old male infant who presented with cough, dyspnoea and failure to thrive over the past 10 days. X-rays revealed a bilateral reticular pattern with non homogeneous opacities. Computed Tomography (CT) of the chest showed features consistent with interstitial lung disease. High-resolution Computed Tomography (HRCT) demonstrated a crazy-paving appearance, suggestive of interstitial lung disease or a surfactant-related genetic disorder. Bronchial Alveolar Lavage (BAL) yielded milky fluid. Characteristic microscopic findings on lung biopsy included the filling of terminal bronchioles and alveolar spaces with deep pink granular Periodic Acid Schiff (PAS)-positive eosinophilic material, while the alveolar architecture remained preserved. Patients with minimal symptoms are managed conservatively, whereas those with hypoxaemia require a more aggressive approach. Whole Lung Lavage (WLL) is the safest and most effective form of treatment. To date, there have been 240 case reports and 410 case series documented in the literature. This is the first case of PAP reported in the study institution. The authors present this case report here due to its rarity and diagnostic significance.

Marjolins Ulcer: Clinicopathological Profile and Treatment Patterns

Purpose: Marjolins ulcer is a malignant transformation arising from chronic ulcers or previously traumatized scars that occur usually after burns. This article aims to study the clinicopathological profile and treatment patterns of Marjolins ulcer.
 Materials and Methods: Retrospective analysis of all Marjolins ulcer patients presented to Vydehi Cancer Centre from 2018 to 2021 was done. A total of 27 patients of all age groups were included in the study. All information regarding detailed history, clinical examination, treatment details were retrospectively collected and analysed.
 Results: Most of the patients were in the 5th decade of life with an overall male preponderance. The most common cause for Marjolins ulcer was Burns scars followed by Trauma. Lower extremities were found to be the most predominant site. The mean latency period for the development of Marjolins ulcer was 11 years. Squamous cell carcinoma was the most common histological subtype, Adjuvant Radiotherapy was given to the patients with high-risk features.
 Conclusion: Chronic non-healing ulcers that do not respond to treatment should be carefully examined for malignant transformation. Surgery is the mainstay of treatment and Adjuvant Radiotherapy should be considered in high-risk cases to reduce locoregional recurrence.

POST-CHOLECYSTECTOMY SYNDROME: A STUDY OF 200 CONSECUTIVE PATIENTS WITH GALL BLADDER PATHOLOGY WHO UNDERWENT LAPAROSCOPIC CHOLECYSTECTOMY

Post-cholecystectomy syndrome (PCS) is a medical condition that can develop after cholecystectomy. It is characterized by several gastrointestinal symptoms, including abdominal pain, dyspepsia, bloating, and diarrhea, which can limit patients' quality of life. Understanding the underlying cause, risk factors, and effective intervention is essential to improve patient safety in clinical practice. This study aims to evaluate the frequency of post-cholecystectomy syndrome (PCS), analyze its symptoms and demographic features, and identify likely risk factors. This observational longitudinal study included 200 patients who underwent laparoscopic cholecystectomy in the surgical department of Shaikh Zayed Hospital Lahore between Jan 1st, 2021, and Jan 1st, 2022. Data were retrieved from electronic medical records, and patients were followed for PCS. The data was analyzed using SPSS software, version 25. Of 200 patients, 45 (22.5%) were diagnosed with Pcs. The ratio of males to females was 1:1.64. Age ranges from 19-78, and most belong to the 5th decade of life. Common symptoms are right upper quadrant abdominal pain in 33 (73.3%), nausea in 23 (51.1%), dyspepsia, vomiting in 16 (35.6%), and presenting signs included right hypochondriac region tenderness in 18 (40%), jaundice and epigastric tenderness in 4 (8.9%) cases. Common causes included Psychiatric disease in 8 (17.8%), helicobacter pylori infection in 7 (15.6%), muscle pathology in 6 (13.3%), and gastritis in 5 (11.11%), respectively. Based on the results it can be concluded that to provide effective treatments for individuals with PCS, it is essential to take signs seriously, conduct a comprehensive evaluation to reach an accurate diagnosis and treat the underlying cause appropriately.

Images of India in the Lithuanian press of Catholic missions, 1927–1940

The article presents the perception of Indian culture and everyday life, formed by the interwar Lithuanian press of the Catholic missions, which received little attention in historiography. Based on the articles published in the Jesuit magazine “Misijos” and the Salesian magazine “Saleziečių žinios” in 3rd and 4th decades of the 20th century, three main images that represented India in Lithuania are examined: Indian spirituality and religiosity, social problems of society, primarily the caste system and women’s rights, and finally the ferocious nature of the land. The analysis of periodicals revealed that the creation of images of India was influenced by the Christian tradition, the European orientalist attitude and the comparison of East-West civilizations.

Relationship between Age, Histologic Grade, Tumour Size, Immunohistochemical Biomarkers Expressions and Molecular Subtypes of Invasive Breast Carcinoma in Ilorin, Nigeria

Background: Background: Invasive breast carcinoma causes the most cancer-related death in women, and age is an essential non-modifiable risk factor. This study determined the relationship between age and histopathologic grade, tumor size, immunohistochemical biomarkers (ER, PR, and HER-2) expressions, and subtypes of invasive breast carcinoma. Methods: This was a retrospective hospital-based study of patients with prior histopathological diagnoses of invasive breast carcinoma. Relevant data, including age, histologic type, grade, tumor size, and hormonal receptor status, were retrieved from the archival pathology request forms. Results: The mean age of study subjects was 52.14 ± 12.14 years. The peak age group was in the 5th decade, accounting for 37.0 (32.7%) cases. Nottingham grade III invasive breast carcinoma accounted for 47 (41.6 %) cases and predominated in the 6th decade, accounting for 17 (50.0%) cases. Majority of the study subjects presented with tumor size greater than 5.0 cm (75.9%). The mean tumor size was 6.87 ± 3.20 cm and ranged from 3.2 cm to 16.0 cm. The immunohistochemical expressions of ER, PR, and HER-2 biomarkers were 36.3%, 28.3%, and 41.6%, respectively, particularly in the 5th and 6th decades. Also, Luminal A, Luminal B, Triplenegative, and HER-2 enriched subtypes occurred in 16.8%, 20.4%, 42.4%, and 20.4% cases respectively in the 5th and 6th decades. However, the triple-negative subtype was found in the 4th to 6th decades in equal proportions. Conclusion: This study observed triple-negative invasive breast carcinoma immunohistochemical subtypes with age association from the 4th to 6th decade

Education on Rural Construction Issues in Lithuania, 1918–1940

In this article the education of farmers and craftsmen about the construction of modern farmsteads during interwar period is assessed. Information on the subject was collected from interwar press and archival documents. The main features of modern interwar farmsteads are rational structuring, compliance with hygiene requirements, comfortability and aestheticism. These ideas were propagated by state institutions, although up to the 3rd decade it was not fully established. When the administration of rural construction matters was commissioned to the Žemės ūkio rūmai, the most important works in this direction were carried out. The Construction Department was established in 1929, and the construction technicians who worked there were the key players in the promotion of the conceptual framework. Therefore, their proper training and the provision of the necessary number of specialists was an essential prerequisite for the purposeful education of farmers and building tradesmen.
 Organising education for farmers one of the main goals was to achieve the largest possible number of persons and thus promote the importance of the implementation of the ideas of modernization of rural construction. Therefore, for this, the periodical press, educational publications, short-term courses and lectures on the issues of improving rural construction and the management of homesteads, as well as exhibitions where construction technologies were demonstrated and specialist advice was provided, were actively used for this. Given the gradual increase in farmers’ interest in the ideas promoted, as well as their active participation in the educational programmes, there is no doubt that the measures chosen were quite successful.
 Rural craftsmen also played an equally important role in the modernisation campaign. Therefore, since the end of the 1930s, short courses have been organised annually to raise their qualifications. The scope of these works was rising, although it affected only part of craftsmen and did not solve the lack of qualified specialists. In the 4th decade, the new laws and rules of rural building regulation were implemented. Also, the necessity for higher number of qualified construction craftsmen that would be able to implement modern building principles was realized. This resulted in first specialized craft schools for carpenters, masons and furnace workers. It was thought that these schools together with earlier courses had to form construction craftsmen education system. Although work in this direction was halted shortly afterwards, the establishment of the specialised schools was an indication of the prioritisation of construction issues and thus of the implementation of modernisation principles.

Cumulative Frailty in Late‐Middle Aged Men is Associated with Later Regional Abnormal White Matter and Decreased Processing Speed

AbstractBackgroundFrailty refers to a person’s physical and functional capabilities and increases during aging. Abnormal white matter (AWM; e.g., hyperintensities on T2‐weighted MRI) is a neuroimaging marker of small‐vessel vascular disease associated with increased risk of Alzheimer’s Disease and related dementias. While some studies have found associations between frailty indices (FIs) and global AWM, their association with accumulation of regional AWM and any related cognitive correlates is understudied.Method342 men from the Vietnam Era Twin Study of Aging with frailty measured at study baseline (mean age = 56.4) and structural MRI scans at follow‐up (mean 5.5 years later) were included (Table 1). The FI measure was based on a cumulative deficit model[1] using an index of 37 health‐ and function‐related items. Global AWM was defined using morphological operators on multi‐channel, three‐class tissue segmentation[2]. A novel watershed routine, applied to our AWM frequency atlas, generated 5 distinct AWM parcellations: frontal, posterior, anterior periventricular, deep, and temporal stem (Figure 1A). Cognitive factor scores (memory, processing speed, executive function, fluency) were derived from normative neuropsychological test performance.ResultMixed‐effects linear regression models controlling for age, years of education and twin‐pair demonstrated that higher baseline FI was associated with greater future AWM volume in temporal stem (p = 0.03) and anterior periventricular (p = 0.02) regions, but not for global or other parcellations (Figure 1B). Baseline FI was not cross‐sectionally associated with any cognitive factor score but was associated longitudinally with decreased processing speed (p = 0.002) (Table 2).ConclusionHigher cumulative frailty in late‐middle aged men was associated with greater future AWM burden and greater decline in processing speed. These findings suggest that cumulative frailty during the 6th decade is a relevant indicator and possible predictor of future pathological structural and functional processes in the brain. Longitudinal studies may elucidate whether frailty affects AWM progression and cognitive decline along a common causal pathway.

Alzheimer Plasma Biomarkers Distinguish SuperAgers from their Cognitively Average Peers

AbstractBackgroundSuperAgers are individuals ≥80 years old who were selected for having episodic memory performance that is at least as good as individuals 20‐30 years their junior. We have previously shown that on average SuperAgers show lower neurofibrillary tangle density in the entorhinal cortex than cognitively average controls, which may be one biological factor contributing to superior memory beyond the 8th decade. This preliminary study investigated whether plasma concentrations of Alzheimer and related neurodegenerative biomarkers differ between SuperAgers and their cognitively average peers.MethodSuperAgers (N = 61) and Cognitively Average Controls (N = 28) were enrolled through the SuperAging Research Program. The plasma biomarkers amyloid β peptide 40 (Aβ40), amyloid β peptide 42 (Aβ42), neurofilament light (NFL), phosphorylated tau‐181 (pTau‐181), and glial fibrillary acidic protein (GFAP) were measured in SuperAgers and Cognitively Average participants using the Quanterix single molecule protein detection (SIMOA) platform. Independent samples t‐tests were used for statistical analyses (significance was set at p<0.05, uncorrected).ResultThere were no significant differences in mean age between SuperAgers and Cognitively Average Controls. Concentrations of Aβ42, Aβ40, the ratio of Aβ42/Aβ40, NFL or GFAP did not significantly differ between groups. On average, SuperAgers and Controls showed pTau‐181 levels that were <16.5 pg/mL, falling within the “Unlikely Alzheimer’s” designation according to Quanterix guidelines. SuperAgers showed significantly lower pTau‐181 levels compared to Cognitively Average Controls [M = 5.42 pg/mL (SD = 2.60) vs M = 7.10 pg/mL (SD = 3.14), respectively].ConclusionPlasma phosphotau biomarkers are promising for the assessment of brain integrity versus degeneration across the age‐Alzheimer continuum. The current results provide preliminary support for the contention that the SuperAger brain may be even more removed from the Alzheimer side of the continuum than neurotypical controls.Emily Rogalski and Changiz Geula contributed equally to this study.

Physiological and behavioral characteristics of SuperAgers from everyday activities: An NIH U19 SuperAging Research Initiative study protocol

AbstractBackgroundStudying factors contributing to exceptional memory performances beyond the 8th decade, can be a valuable model for understanding dementia risk, prevention, and underlying mechanisms. Age‐associated changes in biological and physiological complexity, or system responsivity, form the foundation of the loss of complexity hypothesis in aging (Lipsitz & Goldberger, JAMA, 1992). Project 1 under the multisite NIH U19 SuperAging Research Initiative uses state‐of‐the‐art wearable technology, and data from real‐world contexts, to test the supposition that SuperAgers have preserved physiologic and behavioral complexity relative to their Controls in the domains of physical activity, autonomic responsiveness, sleep, and social engagement.MethodSuperAgers are enrolling from five U.S. and Canadian sites of the SuperAging Research Initiative. SuperAgers refer to individuals aged 80 and older who have memory capacity considered average for those 2‐3 decades younger. In a fully remote data collection protocol, participants wear a multi‐sensor array comprised of 1 skin‐mounted trunk sensor (with ECG) and 2 wearable limb sensors, continuously over a 14‐day period with scheduled rest breaks every 3‐4 days. Participants complete a baseline orientation visit, and three brief check‐in visits with the study team over video conference. Using custom algorithms, developed by our research team, we will examine time‐varying changes in indices of physiologic and behavioral complexity, across multiple body systems, using both volume‐based and established multi‐scale entropy approaches to quantify differences between SuperAgers and their typically aging Controls. We plan to analyze sensor derived complexity metrics in relation to self‐reports of life‐space mobility.ResultWe will overview our remote data collection protocol and semi‐automated analytics pipeline. Barriers and facilitators to remote data collection will be discussed Preliminary data (N = ∼ 40) will be presented, with select case study examples. We will provide preliminary sensor adherence and user‐feedback from the cohort, comprised of a diverse sample of SuperAgers and Controls.ConclusionThis is the first study to test the loss of complexity hypothesis across multiple physiological and behavioral domains simultaneously and in exceptional cognitive aging. Using sensitive tools to capture dynamic and complex behaviors, we will characterize SuperAgers in a way not afforded by point‐in‐time assessments that dominate the current literature.

Correlation of Clinical and Histopathological Features of Salivary Pleomorphic Adenoma.

Salivary gland tumors represent about 3% of the head and neck tumors. Pleomorphic adenoma (PA) is the most common benign salivary gland tumor. This study was conducted to investigate and describe some clinical and histopathological aspects of salivary pleomorphic adenomas with special reference to the epithelial and mesenchymal components. In this retrospective study, one hundred tissue samples diagnosed as PA were sourced from archival tissue blocks between 2009 and 2019 in this retrospective study. Some clinical and demographic features, including age, sex, tumor size, and tumor location were recorded. This study included only samples taken by excisional biopsy. Then, the samples were histologically classified into three subtypes according to the proportion of epithelial and stromal components. The demographic and clinicopathological variables were statistically analyzed using Chi-square test or Fisher's exact test, considering a significance level of 5% (p< .05). In the present study, most cases (61%) were found in females, representing a female-male ratio of 1.6:1. The peak incidence was seen in the 4th and 5th decades of life. In 87% of cases, PA occurred in major salivary glands. There was a significant difference between the age of the patient and squamous metaplasia (p= 0.036). There was also a significant difference between the size of tumor and the amount of myxoid stroma (p= 0.021). Extensive myxoid stromawas mostly seen in tumors larger than 3.37cm (p= 0.001). In addition, there was a statistically significant difference between capsular invasion and the development of squamous metaplasia (p= 0.001). In this study, there was a significant correlation between the gland type and capsular features and between the size of tumor and rate of squamous metaplasia. A detailed clinical and histopathological analysis of PAs may provide a better insight to the pathophysiology of the lesion, tumor cell differentiation, and prognostic factors.

PARAKID: Navigating the relation between paraproteins and kidney lesions: A multi-center retrospective observational study.

Monoclonal gammopathy is a heterogeneous group of disorders due to the clonal proliferation of immunoglobulin-producing plasma cells or B lymphocytes. Patients develop kidney disease not only due to malignant transformation but also due to the idiosyncratic properties of the M protein and the host factors. We aim to study the spectrum of kidney diseases in patients with paraproteinemia. A retrospective observational study was performed at three tertiary care centers in Southern India. Kidney biopsies conducted in these three centers were reviewed from June 1, 2020 to November 30, 2022. All biopsies suggestive of monotypic immunoglobulin or light chain restriction were included in the study. A total of 122 patients were included in the study with an incidence of 2.4%. The mean age was 52.27 ± 13.27 years, and majority (63.1%) were males. AL amyloidosis was most common in the monoclonal gammopathy of renal significance (MGRS) group, and cast nephropathy was most common in the multiple myeloma (MM) group. On histopathology, 83.6% had a single lesion, followed by 14.8% with double lesion, and 1.6% with triple lesion. Paraproteinemia is associated with a myriad of kidney lesions. MGRS and MM are usually present in the 6th decade of life and beyond, while proliferative glomerulonephritis with monoclonal immunoglobulin deposits is more common in the younger age group. Older age group, high creatinine, hyperuricemia, hyperphosphatemia, presence of more than one lesion on kidney biopsy, and presence of cast nephropathy was significantly associated with the requirement of kidney replacement therapy.