Annual Follow-up Research Articles

Impacts of baseline biomarkers on cognitive trajectories in subjective cognitive decline: the CoSCo prospective cohort study

BackgroundSubjective cognitive decline (SCD) is a risk factor for Alzheimer’s disease (AD); however, the rates of cognitive decline are variable according to underlying pathologies and biomarker status. We conducted an observational study and aimed to investigate baseline characteristics and biomarkers related with cognitive declines in SCD. Our study also assessed whether SCD participants showed different cognitive and biomarker trajectories according to baseline amyloid deposition.MethodsThis study is a part of a longitudinal cohort study conducted in multi-centers in South Korea between 2018 and 2021. Individuals (≥ 60 years old) with persistent cognitive complaint despite of normal cognitive functions were eligible for the study. All participants underwent neuropsychological tests, florbetaben PET scans, plasma amyloid markers, and brain MRI scans. Annual follow-up evaluations included neuropsychological tests and assessments for clinical progressions. Regional brain volumetry and amyloid burden represented by PET-based standardized uptake value ratio (SUVR) were measured. We compared cognitive and brain atrophic changes over 24 months between amyloid positive-SCD (Aβ + SCD) and amyloid negative-SCD (Aβ-SCD) groups. Baseline factors associated with cognitive outcomes were investigated.ResultsA total of 120 participants with SCD were enrolled and 107 completed follow-up evaluations. Aβ + SCD participants (n = 20, 18.5%) were older and more frequently APOE4 carriers compared with Aβ-SCD participants (n = 87). Baseline cognitive scores were not different between the two groups, except the Seoul Verbal Learning Test (SVLT) scores showing lower scores in the Aβ + SCD group. After 24 months, plasma amyloid markers were higher, and regional volumes (entorhinal, hippocampal, and pallidum) were smaller in the Aβ + SCD participants compared with Aβ-SCD participants adjusted by age, sex, and baseline volumes. SVLT delayed recall and controlled oral word association test (COWAT) scores indicated more declines in Aβ + SCD participants. Baseline left entorhinal volumes were related to verbal memory decline, while baseline frontal volumes and global SUVR values were related to frontal functional decline.ConclusionAβ + SCD participants showed more cognitive decline and medial temporal atrophic changes during 24 months. Baseline neurodegeneration and amyloid burden were related with future cognitive trajectories in SCD.Trial registrationThis study was registered at CRIS (KCT0003397).

Early Ascertainment of Breast Cancer Diagnoses Comparing Self-Reported Questionnaires and Electronic Health Record Data Warehouse: The WISDOM Study.

The goal of this study was to use real-world data sources that may be faster and more complete than self-reported data alone, and timelier than cancer registries, to ascertain breast cancer cases in the ongoing screening trial, the WISDOM Study. We developed a data warehouse procedural process (DWPP) to identify breast cancer cases from a subgroup of WISDOM participants (n = 11,314) who received breast-related care from a University of California Health Center in the period 2012-2021 by searching electronic health records (EHRs) in the University of California Data Warehouse (UCDW). Incident breast cancer diagnoses identified by the DWPP were compared with those identified by self-report via annual follow-up online questionnaires. Our study identified 172 participants with confirmed breast cancer diagnoses in the period 2016-2021 by the following sources: 129 (75%) by both self-report and DWPP, 23 (13%) by DWPP alone, and 20 (12%) by self-report only. Among those with International Classification of Diseases 10th revision cancer diagnostic codes, no diagnosis was confirmed in 18% of participants. For diagnoses that occurred ≥20 months before the January 1, 2022, UCDW data pull, WISDOM self-reported data via annual questionnaire achieved high accuracy (96%), as confirmed by the cancer registry. More rapid cancer ascertainment can be achieved by combining self-reported data with EHR data from a health system data warehouse registry, particularly to address self-reported questionnaire issues such as timing delays (ie, time lag between participant diagnoses and the submission of their self-reported questionnaire typically ranges from a month to a year) and lack of response. Although cancer registry reporting often is not as timely, it does not require verification as does the DWPP or self-report from annual questionnaires.

Agricultural burning in Imperial Valley, California and respiratory symptoms in children: A cross-sectional, repeated measures analysis

Burning of agricultural fields is an understudied source of air pollution in rural communities in the United States. Smoke from agricultural burning contains air toxics that adversely impact respiratory health. Imperial County in southeastern California is a highly productive agricultural valley that heavily employs agricultural burning to clear post-harvest crop remnants. We related individual-level exposure to agricultural burns to parent-reported respiratory symptoms in children.We leveraged the Children's Assessing Imperial Valley Respiratory Health and the Environment (AIRE) cohort of 735 predominantly Hispanic low-income elementary school students in Imperial County. Parents reported children's respiratory health symptoms and family demographic characteristics in questionnaires collected at enrollment and in annual follow-up assessments from 2017 to 2019. Permitted agricultural burns in Imperial County from 2016 to 2019 were spatially linked to children's geocoded residential addresses. We used generalized estimating equations to evaluate prevalence differences (PDs) in respiratory symptoms with increasing exposure to agricultural burning within 3 km in the 12 months prior to each assessment.Nearly half of children (346, 49 %) lived within 3 km of at least one agricultural burn in the year prior to study enrollment. In adjusted models, each additional day of agricultural burning in the prior year was associated with a one percentage point higher prevalence of wheezing (PD 1.1 %; 95 % CI 0.2 %, 2.0 %) and higher bronchitic symptoms (PD 1.0 %; 95 % CI -0.2 %, 2.1 %). Children exposed to four or more days of burning had an absolute increased prevalence of wheezing and bronchitic symptoms of 5.9 % (95 % CI -0.3 %, 12 %) and 5.6 % (95 % CI -1.8 %, 13 %), respectively, compared to no burn exposure. Associations with wheezing were stronger among children with asthma (PD 14 %; 95 % CI -1.4 %, 29 %).To our knowledge, this is the first U.S. study of agricultural burning and children's respiratory health. This work suggests that reducing agricultural burning could improve children's respiratory health.

Short-term brain atrophy evolution after initiation of immunotherapy in a real-world multiple sclerosis cohort.

In multiple sclerosis (MS), brain atrophy measurements have emerged as an important biomarker reflecting neurodegeneration and disability progression. However, due to several potential confounders, investigation of brain atrophy in clinical routine and even in controlled clinical studies can be challenging. The aim of this study was to investigate the short-term dynamics of brain atrophy development after initiation of disease-modifying therapy (DMT) in a "real-world setting." In this retrospective study, we included MS patients starting DMT (natalizumab, fingolimod, dimethyl fumarate, or interferon-ß1a) or without DMT, availability of a baseline MRI, and two annual follow-up scans on the same MRI system. Two-timepoint percentage brain volume changes (PBVCs) were calculated. Fifty-five MS patients (12 patients starting DMT with natalizumab, 7 fingolimod, 14 dimethyl fumarate, 11 interferon-ß1a, and 11 patients without DMT) were included. We found the highest PBVCs in the first 12 months after initiation of natalizumab treatment. Furthermore, the PBVCs in our study were very much comparable to the results observed by other groups, as well as for fingolimod, dimethyl fumarate, and interferon-ß1a. We found PBVCs that are comparable to the results of previous studies, suggesting that brain atrophy, assessed on 3D MRI data sets acquired on the same 3T MRI, provides a robust MS biomarker.

The Effects of Laparoscopic Sleeve Gastrectomy (LSG) on Obesity-Related Type 2 Diabetes Mellitus: a Prospective Observational Study from a Single Center.

The objective of the study is to evaluate the effects of laparoscopic sleeve gastrectomy (LSG) on mid- to long-term regulation of blood glucose in patients with obesity and type 2 diabetes mellitus (T2DM) MATERIALS AND METHODS : In this prospective and observational single-center study, a total of 234 patients with obesity and a diagnosis of T2DM who underwent LSG between 2015 and 2020 were evaluated. The demographics and laboratory data, consisting of body mass index (BMI), glycosylated hemoglobin (HbA1c%), and fasting plasma glucose (FPG) and total weight loss (TWL%), were compared preoperative and postoperative at 12th and 18th months and annual follow-up for seven consecutive years. The mean age of 234 patients (female(n)/male(n):191/43) included in the study was 44.69±9.72 years, while the preoperative mean BMI, FPG, and HbA1c values were 47.9±6.82, 132.09±42.84 mg/dl, and 7.02±1.35% respectively. The mean rate of weight loss (TWL%), which was 34.7 in the 18 months, decreased to 23.15 in the 7th year. While the HbA1c % value was 7.02±1.35 in the preoperative, it was found 5.71 ± 0.75 (p<0.001) and 6.30 ± 1.77 (p<0.05) at the 18th month and 7th year after the operation, respectively. While the DM remission rate was 71.1% at the postoperative 18th month, it was 45.4% at the 7th year, despite the patients regaining weight in the follow-ups. Our study revealed that LSG resulted in high remission rates that continued for 7 years after the surgery, although sustained improvement or remission of diabetes despite some weight regain after the first 18 months.

Intervention project: follow-up of hypertensive and diabetic users using optimized cardiovascular risk stratification through VBA®

Introduction: Among the main chronic diseases are cardiovascular diseases, with systemic arterial hypertension and diabetes mellitus as important risk factors. The identification of patients with high cardiovascular risk is a priority action in Primary Health Care. The Framingham score is used for this classification. The motivation for this study was the finding of the loss of outpatient follow-up of patients with hypertension and diabetes, which leads to treatment abandonment and a high number of complications. General objective: To implement a monitoring worksheet for hypertensive and diabetic patients in the family health strategy (FHS) and their classification according to Framingham score in low, medium and high risk. Methodology: Hypertensive and diabetic patients were located in the electronic medical record and classified according to the Framingham score using a spreadsheet with VBA computer language in the Microsoft Excel program. Results: A total of 219 medical records were analyzed from September to November 2021. Of the total, 210 users with systemic arterial hypertension (SAH) and 65 with diabetes mellitus (DM). Regarding cardiovascular risk, 86 patients (39.3%) fit into low risk, 37 patients (16.9%) in moderate/intermediate risk and the rest, 96 patients (43.8%) in high cardiovascular risk. Conclusion: The expected results with the organization of users with optimized spreadsheets bring improvements such as better control of four-monthly, six-monthly or annual follow-up according to the classification of cardiovascular risk, active search for absentees through community health agents with guidance on the importance of follow-up in PHC, community health indicators in relation to hypertensive and diabetic patients and targeting intervention proposals aimed at the population at higher risk such as lectures, physical activity groups and conversation circles on the subject. In addition, it is essential to note that there is a high number of consultations for this study group, and monitoring with nursing through its protocols is essential to contribute to improving health care.

Genome-wide association study of treatment-related toxicity two years following radiotherapy for breast cancer

Background and purposeUp to a quarter of breast cancer patients treated by surgery and radiotherapy experience clinically significant toxicity. If patients at high risk of adverse effects could be identified at diagnosis, their treatment could be tailored accordingly. This study was designed to identify common single nucleotide polymorphisms (SNPs) associated with toxicity two years following whole breast radiotherapy. Materials and MethodsA genome-wide association study (GWAS) was performed in 1,640 breast cancer patients with complete SNP, clinical, treatment and toxicity data, recruited across 18 European and US centres into the prospective REQUITE cohort study. Toxicity data (CTCAE v4.0) were collected at baseline, end of radiotherapy, and annual follow-up. A total of 7,097,340 SNPs were tested for association with the residuals of toxicity endpoints, adjusted for clinical, treatment co-variates and population substructure. ResultsQuantile-quantile plots showed more associations with toxicity above the p < 5 × 10-5 level than expected by chance. Eight SNPs reached genome-wide significance. Nipple retraction grade ≥ 2 was associated with the rs188287402 variant (p = 2.80 × 10-8), breast oedema grade ≥ 2 with rs12657177 (p = 1.12 × 10-10), rs75912034 (p = 1.12 × 10-10), rs145328458 (p = 1.06 × 10-9) and rs61966612 (p = 1.23 × 10-9), induration grade ≥ 2 with rs77311050 (p = 2.54 × 10-8) and rs34063419 (p = 1.21 × 10-8), and arm lymphoedema grade ≥ 1 with rs643644 (p = 3.54 × 10-8). Heritability estimates across significant endpoints ranged from 25% to 39%. Our study did not replicate previously reported SNPs associated with breast radiation toxicity at the pre-specified significance level. ConclusionsThis GWAS for long-term breast radiation toxicity provides further evidence for significant association of common SNPs with distinct toxicity endpoints.

Poster 365: Initial outcomes after unicompartmental tibiofemoral bipolar osteochondral and meniscus allograft transplantation in the knee using high-viability tissues

Objectives: To report initial outcomes for unicompartmental tibiofemoral bipolar osteochondral allograft transplantation (OCAT) with meniscus allograft transplantation (MAT) using fresh high-cell- viability tissues for treatment of knee articular cartilage defects with meniscus deficiency. The study was designed to test the hypothesis that primary OCAT and MAT using high-viability tissues will be associated with successful short-term (2 to 6 years) outcomes based on statistically significant and clinically meaningful improvements in pain and function in the majority of patients. Methods: With IRB approval and documented informed consent, patients who underwent primary OCAT and MAT for large articular cartilage defects with meniscus deficiency involving at least one femoral condyle, tibial plateau, and meniscus, all of which were opposing (bipolar). Surgeries were defined as Uni when patients underwent OCAT and MAT involving one femoral condyle, tibial plateau, and meniscus in the same compartment or Uni-Plus when patients underwent Uni OCAT and MAT with at least one other OCA transplant to treat a large (&gt;2.5cm2) grade III or IV focal articular cartilage defect of the patella, trochlea, femoral condyle, or tibial plateau. Patients who had at least 2-year follow up data regarding complications, failures, adherence, and patient reported outcome measures (PROMs) were analyzed. Patients who required OCA and/or MAT revision or artificial arthroplasty were defined as treatment failures. Patient reported outcome measures (PROMs) including VAS pain, IKDC, SANE, PROMIS Global Health and Physical Function, were collected at 3 and 6 months and then yearly after transplantation. Outcomes were compared based on patient sex, age, and BMI, tobacco use, previous and concurrent procedures, differences in number of surfaces transplanted (Uni vs Uni-Plus), and adherence. Significance was set at P &lt; 0.05. Differences in PROMs were also assessed for minimum clinically important differences. Results: Seventy-six patients (n=52 males; 68%) met inclusion criteria (mean followup = 52 months; median = 56 months; range, 24-70 months). Mean age was 41.1 years (range, 15-69 years) and mean body mass index (BMI) was 28.9 kg/m2 (range, 17-46). Forty-eight patients underwent OCAT(s) in addition to Uni (Uni-Plus). Eight patients (10.5%) underwent concurrent ACL reconstruction, and 28 patients (36.8%) underwent ipsilateral lower extremity osteotomy in order to address co-morbidities. Twenty-three patients (30.3%) were documented to be non-adherent during the first year after transplantation. Initial (&gt;2-year) success rate was 77.6% with 8 patients (10.5%) undergoing OCA and/or MAT revision and 9 patients (11.8%) converted to arthroplasty. Variables associated with increased risk for treatment failure (revision or arthroplasty) included ipsilateral osteotomy (p = .046; OR = 3.3), ipsilateral concurrent procedure (p = .0057; OR = 5.5), and non-adherence (p = .0009; OR = 7.2). None of the patients undergoing OCA and/or MAT revision surgery in the present study required arthroplasty at the time of data analysis such that overall success rate for primary and revision unicompartmental bipolar OCA plus MAT was 88.2%. There were statistically significant (p &lt; .0001) and clinically important improvements from preoperative levels for all patient reported outcomes at each annual follow-up time point. Conclusions: Unicompartmental tibiofemoral bipolar osteochondral and meniscus allograft transplantation can result in successful short-term (2 to 6 years) outcomes and satisfaction in the majority (78%) of patients. Primary MOPS-preserved OCAT and MAT for treatment of femoral condyle and tibial plateau articular cartilage defects with concurrent meniscus deficiency was associated with statistically significant and clinically meaningful improvements in patient-reported measures of pain and function.

Lost to follow-up: Post-operative polysomnography in at-risk, pediatric obstructive sleep apnea

Analyze adherence to AASM recommendations for post-operative polysomnography in eligible pediatric patients.Retrospective Cohort.Tertiary, Outpatient Sleep Lab.We conducted a retrospective analysis of pediatric patients, ages 1-17, previously diagnosed with moderate-severe obstructive sleep apnea that completed a surgical intervention. Chart review included demographic data, a co-morbidity of interest, the presence of an otolaryngology, primary care, or sleep medicine encounter, time to follow-up, the presence of a post-operative polysomnography, time to post-operative polysomnography, and the presence of an annual follow-up with any provider.Of the 373 patients, 67 patients met inclusion criteria. Fifty-nine followed-up with any provider, with 21 completing post-operative polysomnography. Patients with residual or recurrent symptoms (p < 0.01) and all patients with severe obstructive sleep apnea (p = 0.04) were more likely to complete post-operative polysomnography (PSG). Sub-analysis across at-risk categories (isolated moderate, isolated severe, moderate & a co-morbidity, and severe & a co-morbidity) revealed patients with severe obstructive sleep apnea & a co-morbidity completed a follow-up PSG more often than isolated moderate obstructive sleep apnea (p = 0.01). There was a difference in follow-up with sleep medicine across at-risk categories (p < 0.01).Recurrent symptoms and increasing disease severity were associated with obtaining post-operative polysomnography. However, variability existed for which patients completed post-operative polysomnography. We speculate an inconsistent standard across disciplines, inadequate post-operative obstructive sleep apnea management education, and uncoordinated systemic processes contribute to this discrepancy. Our findings support a standardized, multi-disciplinary care pathway for the management of at-risk, pediatric obstructive sleep apnea.

Social inequalities, stressful work and non-fatal cardiovascular disease: follow-up findings from the CONSTANCES Study

BackgroundStudies show that a disadvantaged socioeconomic position (SEP) and psychosocial stress at work are both independently associated with an increased risk of cardiovascular disease (CVD). But it is not clear...

BG13 A rare case of Muir–Torre syndrome

Abstract Muir–Torre syndrome is a rare variant of hereditary nonpolyposis colorectal cancer, also known as Lynch syndrome. It is caused by a defect in mismatch repair genes, which are most commonly inherited in an autosomal dominant fashion. It is characterized clinically by sebaceous neoplasms of the skin associated with at least one visceral malignancy, with colon cancer being the most frequent. The most common genetic defects responsible are in MLH1, MSH2 and MSH6, which results in an increased frequency of unrepaired base mismatching during DNA replication and subsequent microsatellite instability, predisposing to cancer. We present a case of a 59-year-old man with a history of colon cancer who was referred with a rapidly growing irregular nodule on his lower back for the past 2 months, concerning for an amelanocytic melanoma. An excision biopsy was arranged, and subsequent histology demonstrated a sebaceoma. Immunohistochemistry for mismatch repair genes showed loss of expression for MSH2 and MSH6. Upon further questioning, it was found that he had a strong family history of colon cancer (father, brother and two sisters), and he developed colon cancer at 36 years of age, which was treated with a pancolectomy. Genetic testing revealed a mutation in MSH2. Given this history, annual follow-up was arranged for skin surveillance.

1821-PUB: Relationship between Time in Range and Glucose Management Indicator in Adolescents and Children with Type 1 Diabetes Mellitus

Objective: To investigate the relationship between time in range (TIR, 3.9-10.0mmol/L) and glucose management indicator (GMI) in adolescents and children with type 1 diabetes mellitus (T1DM) and explore the impact of coefficient of variation (CV) on their relationship. Methods: Data derived from continuous glucose monitoring (CGM) and other clinical data (including age, duration of T1DM, and laboratory-measured HbA1c) were obtained from the annual follow-up of the Guangdong T1DM Translational Medicine Study. The patients under 18 years old were included. The patients were divided into CV≤36% group and CV&amp;gt;36% group by the attainment of CV. The relationship between TIR and GMI of both groups was assessed with correlation coefficient. Further, patients were divided into 4 groups by the interquartile range of CV. The linear regression model was used to calculate the TIR predicted value corresponding to the same GMI in 4 groups. Results: The 56 eligible datasets collected from May 2014 to August 2021 were included. The median age, duration of T1DM, and laboratory-measured HbA1c were 14.00 (12.00, 16.00) years, 4.15 (1.66, 5.29) years, and 9.00 (7.65, 11.23) %, respectively. The median TIR, GMI, CV, and valid number of days the CGM device was worn were 60.73 (42.59, 77.72) %, 7.37 (6.78, 8.56) %, 30.38 (24.87, 34.94) %, and 3.39 (2.97, 4.84) days, respectively. TIR and GMI were highly linear correlated (R2=0.89, p&amp;lt;0.001), and a significantly higher Spearman’s correlation coefficient was observed in the CV≤36% group than in CV&amp;gt;36% group ((R2=0.92, p&amp;lt;0.001) vs. (R2=0.63, p=0.004)). When the GMI was 7%, the corresponding TIR predicted values gradually decreased with the increase of CV, which were 75.66% (CV≤24.87%), 73.48% (24.87%&amp;lt;cv≤30.38%), 69.16% (30.38%34.94%). Conclusions: TIR and GMI were highly linear correlated in adolescents and children with T1DM. With constant GMI, the less the glycemic fluctuation, the higher the TIR.&amp;lt;/cv≤30.38%), 69.16% (30.38% Disclosure M.Lei: None. J.Lv: None. X.Mai: None. H.Deng: None. C.Wang: None. D.Yang: None. X.Yang: None. W.Xu: None. J.Yan: None. Funding Science and Technology Planning Project of Guangzhou (202102010154)

Recurrent cardiac hydatid cysts with pericardial protrusion; a rare case presentation of Echinococcus granulosus

Hydatid cyst (HC) is a rare pathology mostly found in less developed, livestock-raising countries. HC can be found anywhere in the body, however it is a rare finding in the heart, and its recurrence in the heart and pericardium is very rare. A 54-year-old woman who had undergone surgery for the removal of HC in another country 11 years before presented with shortness of breath and heaviness in the chest. The examinations and computerized tomography (CT) scan revealed a large mass measuring 60×50 mm in the pericardium cavity originating from the right atrial wall. Infection with Echinococcus granulosus was confirmed with serological enzyme-linked immunosorbent assay (ELISA) test and the patient underwent cardiac surgery. The patient underwent cardiopulmonary bypass, nevertheless did not suffer cardiac arrest, and aortic cross-clamping was not performed for her. The removed mass was filled with daughter cysts. The endocysts were removed and intramural cysts were drained. Following the surgery, the patient received treatment with albendazole for six months. Cardiac hydatid cyst recurrence is a rare but possible incident, and annual follow-ups and echocardiography are recommended.

Long-Term Results with 187 Frozen Elephant Trunk Procedures.

The frozen elephant trunk (FET) technique is an established therapeutic option in the treatment of complex aortic diseases. We report our long-term clinical outcomes after FET repair. A total of 187 consecutive patients underwent FET repair at our department between 8/2005 and 3/2023. Indications included acute and chronic aortic dissections and thoracic aneurysms. Endpoints included operative morbidity and mortality, long-term survival, and the need for reinterventions. Operative mortality, spinal cord injury and permanent stroke rates were: 9.6%, 2.7% and 10.2%, respectively. At five years, overall survival was 69.9 ± 3.9% and freedom from aortic-related death was 82.5 ± 3.0%, whereas at ten years, overall survival was 53.0 ± 5.5% and freedom from aortic-related death was 75.8 ± 4.8%. Sixty-one reinterventions on the thoracic aorta were necessary. Freedom from secondary interventions at ten years was 44.7 ± 6.4% overall (63.1 ± 10.0% for acute dissections, 40.8 ± 10.3% for chronic dissections and 28.9 ± 13.1% for aneurysms, respectively). The high reintervention rate for chronic dissections and for aneurysms is related to the pre-existing aortic pathology. Late aortic growth of untreated segments with potentially fatal outcome occurs even after ten years, so careful annual follow-up is mandatory in this patient cohort.

#6011 VIRAL INFECTION AND DE NOVO PRODUCTION OF DONOR SPECIFIC ANTIBODIES IN KIDNEY TRANSPLANTATION: DCD VS DBD

Abstract Background and Aims Viruses are among the most common causes of opportunistic infection after transplantation and an accurate screening and follow-up is needed in order to prevent related complication as systemic damages and worsening of kidney function. On the other hand, in the first years after transplantation, antibody-mediated rejection (ABMR) is one of the first cause of graft lost and de novo production of donor specific antibody (dnDSAs) is the main source. In this monocentric study we analysed data of 255 patient transplanted from January 2016 to February 2022. We studied the incidence of viral infection and dnDSAs in the first one year after transplantation in different sub-groups of patients. Method Data was obtained from our monocentric registry, from January 2016 to February 2022. Starting from 299 kidney transplantation we obtained 255 patients with a complete annual follow-up for viral infection and DSA monitoring. We compared the incidence of viral infection and dnDSAs in different sub-group: transplanted from donation after brain-death treated with Basiliximab as induction therapy (DBDb), transplanted from donation after brain-death treated with rabbit anti-human thymocyte immunoglobulin (rATG) as induction therapy (DBDt), transplanted from donation after circulatory death treated with rATG as induction therapy (DCD) and transplanted treated with rATG as induction (DBDt+DCD). Results Global incidence of viral infection was 73% and dnDSAs formation was present in 12,5% of all patients. DBDs showed an incidence of 69% of viral infection and 10% of dnDSAs while in DBDt these values were 77,4% and 25%, respectively. In DCD data of viral infection was higher (96,7%) whereas dnDSAs was 14%. rATG (DBDt+DCD) displayed 87,1% of viral infection and 19% of dnDSAs. Conclusion Viral infection and dsDNAs are two paramount aspects in kidney transplantation and demonstrate different incidences depending on donation profile and immunosuppressive induction therapy. Specifically rATG seems to be associated to an higher rate of viral infection and DCD is the more relevant sub-group. Furthermore, rATG was associated with higher dsDNAs rate, especially in DBD treated with rATG. On the best of our knowledge, this data was never observed before. These data, due to the low number of cases, need to be confirmed from larger cohorts. Moreover our study underlines how significant is to develop a personalized approach in order to reduce complications associated to immunosuppressive therapies.

Emotional and behavioral problems change the development of cerebellar gray matter volume, thickness, and surface area from childhood to adolescence: A longitudinal cohort study.

Increasing evidence indicates that major neurodevelopmental disorders have potential links to abnormal cerebellar development. However, the developmental trajectories of cerebellar subregions from childhood to adolescence are lacking, and it is not clear how emotional and behavioral problems affect them. We aim to map the developmental trajectories of gray matter volume (GMV), cortical thickness (CT), and surface area (SA) in cerebellar subregions from childhood to adolescence and examine how emotional and behavioral problems change the cerebellar development trajectory in a longitudinal cohort study. This population-based longitudinal cohort study used data on a representative sample of 695 children. Emotional and behavioral problems were assessed at baseline and at three annual follow-ups with the Strengths and Difficulties Questionnaire (SDQ). Using an innovative automated image segmentation technique, we quantified the GMV, CT, and SA of the whole cerebellum and 24 subdivisions (lobules I-VI, VIIB, VIIIA&B, and IX-X plus crus I-II) with 1319 MRI scans from a large longitudinal sample of 695 subjects aged 6-15 years and mapped their developmental trajectories. We also examined sex differences and found that boys showed more linear growth, while girls showed more nonlinear growth. Boys and girls showed nonlinear growth in the cerebellar subregions; however, girls reached the peak earlier than boys. Further analysis found that emotional and behavioral problems modulated cerebellar development. Specifically, emotional symptoms impede the expansion of the SA of the cerebellar cortex, and no gender differences; conduct problems lead to inadequate cerebellar GMV development only in girls, but not boys; hyperactivity/inattention delays the development of cerebellar GMV and SA, with left cerebellar GMV, right VIIIA GMV and SA in boys and left V GMV and SA in girls; peer problems disrupt CT growth and SA expansion, resulting in delayed GMV development, with bilateral IV, right X CT in boys and right Crus I GMV, left V SA in girls; and prosocial behavior problems impede the expansion of the SA and lead to excessive CT growth, with bilateral IV, V, right VI CT, left cerebellum SA in boys and right Crus I GMV in girls. This study maps the developmental trajectories of GMV, CT, and SA in cerebellar subregions from childhood to adolescence. In addition, we provide the first evidence for how emotional and behavioral problems affect the dynamic development of GMV, CT, and SA in the cerebellum, which provides an important basis and guidance for the prevention and intervention of cognitive and emotional behavioral problems in the future.

Evaluation of the Blood-Brain Barrier, Demyelination, and Neurodegeneration in Paramagnetic Rim Lesions in Multiple Sclerosis on 7 Tesla MRI.

Paramagnetic rim lesions (PRLs) are associated with chronic inflammation in multiple sclerosis (MS). 7-Tesla (7T) magnetic resonance imaging (MRI) can evaluate the integrity of the blood-brain barrier (BBB) in addition to the tissue myelination status and cell loss. To use MRI metrics to investigate underlying physiology and clinical importance of PRLs. Prospective. Thirty-six participants (mean-age 47, 23 females, 13 males) of mixed MS subtypes. 7T, MP2RAGE, MULTI-ECHO 3D-GRE, FLAIR. Lesion heterogeneity; longitudinal changes in lesion counts; comparison of T1, R2*, and χ; association between baseline lesion types and disease progression (2-3 annual MRI visits with additional years of annual clinical follow-up). Two-sample t-test, Wilcoxon Rank-Sum test, Pearson's chi-square test, two-group comparison with linear-mixed-effect model, mixed-effect ANOVA, logistic regression. P-values <0.05 were considered significant. A total of 58.3% of participants had at least one PRL at baseline. Higher male proportion in PRL+ group was found. Average change in PRL count was 0.20 (SD = 2.82) for PRLs and 0.00 (SD = 0.82) for mottled lesions. Mean and median pre-/post-contrast T1 were longer in PRL+ than in PRL-. No differences in mean χ were seen for lesions grouped by PRL (P = 0.310, pre-contrast; 0.086, post-contrast) or PRL/M presence (P = 0.234, pre-contrast; 0.163, post-contrast). Median χ were less negative in PRL+ and PRL/M+ than in PRL- and PRL/M-. Mean and median pre-/post-contrast R2* were slower in PRL+ compared to PRL-. Mean and median pre-/post-contrast R2* were slower in PRL/M+ than in PRL/M-. PRL presence at baseline was associated with confirmed EDSS Plus progression (OR 3.75 [1.22-7.59]) and PRL/M+ at baseline with confirmed EDSS Plus progression (OR 3.63 [1.14-7.43]). Evidence of BBB breakdown in PRLs was not seen. Quantitative metrics confirmed prior results suggesting greater demyelination, cell loss, and possibly disruption of tissue anisotropy in PRLs. 2 TECHNICAL EFFICACY: Stage 2.

Longitudinal Associations Between Food Insecurity and Suicidal Ideation Among Adults Aged ≥65 in the Korean Welfare Panel Study.

Objectives : This study aimed to explore longitudinal associations between food insecurity and suicidal ideation, and the moderating roles of intervention programs. Methods: Data were derived from the 2012-2019 waves of the Korean Welfare Panel Study. Participants aged 65 at baseline (n = 4,425) and their annual follow-up measurements for a mean of 6.58years were included. Conditional fixed effects logistic regressions were used to test 1) associations between food insecurity and the onset of suicidal ideation; 2); whether associations were attenuated by food assistance and income support programs. Results: Food insecurity was associated with higher odds of suicidal ideation in the full sample (OR, 1.77; 95% CI, 1.37-2.29), among women (OR, 1.67; 95% CI, 1.24-2.26) and men (OR, 2.06; 95% CI, 1.25-3.40). The association between food insecurity and suicidal ideation was attenuated by participation in home-delivered meal services (OR, 0.43; 95% CI, 0.21-0.88). Conclusion: Food insecure older adults were more likely to consider committing suicide than their food secure counterparts. Food assistance through home-delivered meal services, but not other intervention programs, could weaken this link.

Early Detection of Dementia using Risk Classification in MCI: Outcomes of Shanghai Mild Cognitive Impairment Cohort Study.

The purpose of this study is to identify the risk factors and risk classification associated with the conversion from mild cognitive impairment (MCI) to Alzheimer's disease (AD) dementia to facilitate early intervention and the design of clinical trials for AD. The study comprised a prospective cohort study of 400 subjects with MCI who had annual follow-ups for 3 years. During an average follow-up period of 3.5 years, 109 subjects were diagnosed with all cause of dementia, of whom 104 subjects converted to Alzheimer's dementia and 5 subjects converted to other types of dementia. The cumulative conversion rate was 5.5% (95% CI: 3.4, 8.6), 16.3% (95% CI: 12.9, 21.1), and 31.0% (95% CI: 25.4, 36.5) in each of the first 3 follow-up years, respectively. The factors associated with a greater risk of conversion from MCI to AD included smoking status, ApoE4 carrier status, right hippocampal volume (rt. HV), left temporal lobe volume, and scores on the Revised Chinese version of the Alzheimer's Disease Assessment Scale-Cognitive Subscale 13 (ADAS-Cog-C). The risk classification of the ADAS-Cog-C or Preclinical Alzheimer Cognitive Composite (PACC) score combined with the rt. HV showed a conversion difference among the groups at every annual follow-up. A simple risk classification using the rt. HV and neuropsychological test scores, including those from the ADAS-Cog-C and PACC, could be a practicable and efficient approach to indentify individuals at risk of all-cause dementia.

Chemotherapy induced peripheral neuropathy (CIPN) and biomarkers of gut microbial translocation in long-term survivors of testicular germ cell tumors.

e17032 Background: Survivors of testicular germ cell tumors (GCT) may suffer from long-term treatment induced peripheral neuropathy. We hypothesized markers of gut microbial translocation after chemotherapy and/or radiotherapy may be contributing factors of peripheral neuropathy. Methods: GCT survivors (N = 194) from National Cancer Institute of Slovakia completed the EORTC QLQ Chemotherapy-Induced Peripheral Neuropathy (CIPN20) questionnaires during their annual follow-up visit at 10-year median (range 2-25). Biomarkers of gut microbial translocaion and dysbiosis (GMT) lipopolysaccharide (LPS), high mobility group box-1 (HMGB-1), d-lactate and sCD14 were measured from peripheral blood obtained during the same visit. Upon obtaining the scores from questionnaires per recommended guidelines, each score was correlated with biomarkers of GMT scored as as high or low (above and below median). Survivors were treated with orchiectomy only (N = 30), cisplatin-based chemotherapy (N = 135), radiotherapy to the retroperitoneum (N = 14) or both chemotherapy and radiotherapy (N = 10). Results: GCT survivors with higher vs lower plasma levels of HMGB-1 had worse overall CIPN20 score (median ± SD = 18 229.0 ± 13 644.2 vs 17 387.0 ± 5106.6 p = 0.048). Patients with higher vs lower plasma HMGB-1 also had worse motor function (9.0 ± 1.8 vs 8.0 ± 2.3, p = 0.036). Sensory and autonomy subscales of CIPN20 qestionaire did not show significant association with HMGB-1 (both P &gt; 0.05). There was no significant difference in CIPN20 symptom burden associated with LPS, d-lactate and sCD14 (all P &gt; 0.05). Conclusions: HMGB-1 may serve as a promising biomarker of CIPN20 in long-term cancer survivors. Proinflammatory pathways are suggested as underlying mechanism of CIPN. Furhter research and larger patient cohorts are needed to explore the pathogenesis of CIPN in GCT survivors.