Concurrent Disease Research Articles

BIOS-03. CLINICAL PRESENTATION, MANAGEMENT, AND OUTCOME IN NEUROLYMPHOMATOSIS: A SYSTEMATIC REVIEW AND ANALYSIS OF INDIVIDUAL PATIENT DATA FROM 459 CASES

Abstract BACKGROUND Neurolymphomatosis (NL) refers to lymphomatous infiltration of the peripheral nervous system (PNS). NL diagnosis and treatment are challenging given the broad differential diagnosis of peripheral neuropathy, the lack of larger cohorts and the subsequent unavailability of prognostic factors or consensus therapy. This study aimed to define characteristics and prognostic factors of NL. METHODS A systematic review of the literature (2004-2023) was performed using PubMed and Scopus databases and reported following PRISMA guidelines. Clinical, radiological, pathological and outcome information were extracted. Multivariable survival analyses were performed using Cox proportional hazard models. RESULTS A total of 459 NL cases from 264 studies were accumulated. NL was the first manifestation of malignancy (primary NL) in 197 patients. PNS relapse of known non-Hodgkin lymphoma (secondary NL) occurred in 262 cases after a median 12 months. NL predominantly presented with rapidly deteriorating, asymmetric painful polyneuropathy. Infiltrated structures included peripheral nerves (56%), nerve roots (52%), plexus (33%) and cranial nerves (32%). Diagnosis was established at a median of 3 months after symptom onset with substantial delays in primary NL. It mainly relied on PNS biopsy or FDG-PET, which carried high diagnostic yields (> 90%). Post mortem diagnoses were rare (3%). Most cases were classified as B-cell (90%) lymphomas. Tumor-directed therapy was administered in 96% of patients and typically consisted of methotrexate or rituximab-based polychemotherapy. Median overall survival was 18 months. Primary NL without concurrent systemic disease outside the nervous system (hazard ratio [HR]: 0.44; 95% confidence interval (CI): 0.25-0.78; p = 0.005), performance status (ECOG < 2, HR: 0.30; 95% CI: 0.18-0.52; p < 0.0001), and rituximab-based treatment (HR: 0.46; 95% CI: 0.28-0.73; p = 0.001) were identified as favorable prognostic markers on multivariable analysis when adjusting for clinical and sociodemographic parameters. CONCLUSIONS Advances in neuroimaging modalities, particularly FDG-PET, facilitate NL diagnosis and offer a high diagnostic yield. Rituximab-based therapy improves NL outcome. Findings may assist clinicians in early recognition, prognostic stratification, and treatment of NL.

Chronic Nasal Disease and Eustachian Tube Function: What Is the Role of Tubomanometry?

Background/objectives: Eustachian tube dysfunction (ETD) presents complex diagnostic challenges in otolaryngology, compounded by concurrent chronic nasal disease. Patient-reported outcome measures (PROMs) often assess ETD severity due to its elusive diagnosis. Tubomanometry (TMM) emerges as a promising diagnostic tool, yet its application alongside chronic nasal disease remains unclear. Our study aims to elucidate TMM’s role in ETD diagnosis within the context of chronic nasal diseases, integrating subjective assessments, clinical examination, and TMM results. Methods: A prospective observational study was conducted with patients suffering from ETD and chronic nasal disease allocated in three different groups according to their nasal pathology. Clinical examination, PROMs in the form of ETDQ-7, and NOSE questionnaires as well as TMM were performed. Results of the above subjective and objective measurements were analysed and correlated statistically to determine the value of TMM in chronic nasal disease patients. Results: All recruited patients suffered from ETD and chronic nasal disease, with similarly affected ETDQ-7 scores across all groups, while NOSE scores differed significantly based on the underground nasal pathology. TMM values confirm the presence of ETD in all three groups, confirming the role of TMM within this cohort. Interestingly, TMM values can still confirm the presence of ETD in patients with chronic nasal disease but cannot discriminate among chronic nasal pathology patients, making TMM a diagnostic tool with uniformity among the chronic nasal pathologies. Conclusions: ETD in individuals with chronic nasal disease presents distinct complexities, requiring a tailored diagnostic approach. In this context, a thorough clinical assessment, integrating ETDQ-7 and NOSE questionnaires, supplemented by TMM where accessible, is crucial to confirm diagnosis. This study confirms that TMM can diagnose ETD in all nasal pathology patients without being influenced by the nature of the disease. This research endeavours to refine diagnostic strategies, enriching clinical decision-making, and enhancing ETD management in patients suffering with chronic nasal diseases.

Beta-2-Microglobulin Maintains Overall Survival Prediction in Binet A Stage Chronic Lymphocytic Leukemia Patients with Compromised Kidney Function in Both Treatment Eras of Chemoimmunotherapy and Targeted Agents

Background: Elevated beta-2-microglobulin (B2M) plasma levels commonly imply a higher CLL-IPI risk category for short overall survival (OS), but the risk model was not adjusted for compromised kidney function and not validated in Binet A stage CLL patients. Methods: CLL patients were identified from 2000 to 2022 at Innsbruck University Hospital, Austria. B2M levels, CLL-IPI risk stratification, and kidney function were assessed. Treatment modalities in case of disease progression and OS data during follow-up were evaluated. Results: A total of 259 Binet A stage CLL patients were identified; 16.9% (n = 44/259) presented with concurrent chronic kidney disease (CKD, GFR < 60 mL/min). Median OS was 170 months and was similar in CKD and non-CKD patients (p = 0.25). The CLL-IPI facilitated prognostic segregation in both CKD (p = 0.02) and non-CKD patients (p = 0.008). Although more frequently elevated in CKD patients (44.1% versus 10.6%, p < 0.001), B2M > 3.5 mg/L remained associated with inferior OS in this subgroup (p = 0.03). Contrary to the CLL-IPI, the prognostic value of B2M alone was also maintained in CLL patients diagnosed and potentially treated frontline in the era of targeted agents (2014–2022, p = 0.03). Conclusions: B2M retains its prognostic value for OS in early-stage CLL patients with concurrent CKD and still represents a promising covariate for up-coming prognostic models to identify patients at high risk for inferior OS in the era of targeted agents.

Nail clubbing, a dermatologic window into underlying systemic disease – an All of Us Study

Introduction Nail clubbing is defined as distal phalanx thickening resulting in a bulbous appearance of the digit. We aimed to describe non-pulmonary medical conditions associated with nail clubbing using a cross-sectional approach. Methods We conducted a cross-sectional analysis of the All of Us Research Program, identifying nail clubbing patients by ICD-10-CM and/or SNOMED code. Nail clubbing patients with pulmonary disease (cases) were compared to nail clubbing patients without pulmonary disease (controls). Fisher’s Exact Test/Pearson’s Chi-Squared Test analyzed categorical variables. Independent Two-Sample t-Tests analyzed continuous variables. Odds ratios were analyzed with multivariate logistic regression adjusted for sociodemographic characteristics. Results In total, 85 participants had nail clubbing, of which 63.53% had a pulmonary disease vs. 36.47% of controls. Overall, across both cases and controls, 22% of patients had chronic liver disease, 17% hypothyroidism, 8% HIV infection, and 5% Graves’ disease/hyperthyroidism. Male vs. female patients with nail clubbing had decreased odds of having concurrent respiratory disease diagnosis (OR, 0.37; 95% CI, 0.14-0.92, p=0.03). Conclusion Greater than one third of patients had nail clubbing associated with a non-pulmonary systemic disease and a significant proportion were male. Consideration of a broad differential of pathologies associated with nail clubbing is needed to initiate workup and make appropriate screening referrals.

Concurrent Myocardial Bridging and Coronary Artery Disease: A Study of an Iranian Population

Background: Myocardial bridging (MB) has been associated with acute coronary syndrome, ischemia, arrhythmia, and even sudden death. This study investigated the prevalence of MB and its complications and manifestations. Methods: This cross-sectional study was conducted on symptomatic coronary patients who underwent angiography between March 2022 and March 2023 at Afshar or Shahid Sadoughi hospitals in Yazd, Iran. The angiographic reports of all patients were evaluated. Cases with MB were selected, and their angiographic films were assessed by an interventional cardiologist for diagnostic accuracy. Baseline, radiological, and clinical characteristics were also evaluated. Data were collected and analyzed using SPSS, version 20.0. The dependent variable was stratified based on independent variables using the χ2 test. Results: Out of 3750 symptomatic patients, 165 (4.4%) were diagnosed with MB. Among these, 111 (67.3%) were male, and the mean age was 56.87±10.06 years. A total of 152 patients had MB in the left anterior descending artery, representing the highest occurrence proportion at 92.1%. The most common types of coronary artery disease (CAD) diagnosed included mono-vessel disease and slow flow, accounting for 35.1% and 25.8%, respectively. There was no significant frequency distribution of CAD co-occurrence based on baseline and radiological features (P>0.050). Conclusion: This study provides valuable insights into the prevalence of MB in Iran and its co-occurrence with CAD. While some findings align with previous research, certain discrepancies warrant further investigation.

Efficacy of Mindfulness Meditation on Patients With Stroke With Concurrent Coronary Heart Disease: A Randomised Controlled Trial.

This study aimed to investigate the efficacy of mindfulness meditation on sleep quality and negative emotions in patients with stroke with concurrent coronary heart disease. This study was a randomised controlled trial. A total of 72 patients with stroke with concurrent coronary heart disease were randomly divided into an observation group and a control group, with 36 patients in each group. The control group received routine treatment plus eszopiclone tablets at a dosage of 3 mg once daily. The observation group received mindfulness meditation in addition to the treatment given to the control group. The Pittsburgh Sleep Quality Index was used to assess sleep status, the Self-Rating Anxiety Scale and Self-Rating Depression Scale were used to assess depression and anxiety, and the Fugl-Meyer Assessment was used to assess motor function. All participants in both groups received a 6-week intervention. Pairwise comparisons revealed that the observation group had better outcomes in sleep quality, sleep onset latency, sleep duration, sleep efficiency, sleep disturbances, daytime function and total scores at both 6 and 12 weeks compared with the control group (p < 0.05). After 12 weeks of intervention, compared with the control group, the total score of sleep quality improved more significantly (9.22 ± 2.35/6.26 ± 2.47). Additionally, different treatment methods had varying effects on anxiety scores, depression scores and motor function scores between the two groups (p < 0.001). Further comparisons showed that the observation group had lower anxiety and depression scores and higher motor function scores at both 6 and 12 weeks compared with the control group (p < 0.05). Mindfulness meditation can effectively improve sleep quality and reduce negative emotions in patients with stroke with concurrent coronary heart disease, as well as promote the recovery of limb functions.

Changes in Erythrocytes in 88 Hyperthyroid Cats.

There is only a limited number of studies that show alterations in erythrocytes in feline hyperthyroidism. Discrepancies between the findings of these studies may be caused by the presence of concurrent diseases and the use of various haematological analysers. This study analysed changes in red blood cells (RBCs) in 88 hyperthyroid cats without concurrent diseases, to identify associations between observed changes and to assess the influence of serum thyroxine (T4) concentration, cat age, and sex, on RBC changes. Among the eighty-eight hyperthyroid cats, erythrocytosis was observed in twelve, anaemia in four, macrocytosis in two, and microcytosis in three. Three of the four cases of anaemia probably resulted from concurrent unrecognised disease. Interestingly, all cases of microcytosis were recognized in cats that had erythrocytosis. This study identified a moderate negative correlation between RBC count and mean corpuscular volume (MCV; r = -0.57, p < 0.001). Concluding, it appears that erythrocytosis may be a response to the development of microcytosis. The correlation between RBC count and MCV in hyperthyroid cats may result from the increased action of hepcidin and erythropoietin coupled with the decreased action of thyroid-stimulating hormone (TSH).

A Pilot Study of the Total Cholesterol/High-Density Lipoprotein Ratio as a Prognostic Indicator of Hyperlipidemia-Related Diseases in Dogs and Cats

In veterinary medicine, the significance of high-density lipoprotein (HDL) measurements is not as well documented as it is in humans. The HDL level can be measured in dogs as well and, through referring to the normal range, it is possible to find out what this means in relation to various endocrine diseases and hyperlipidemia diseases. The aim of this study is to measure the HDL levels in dogs with various conditions and to evaluate whether the total cholesterol (TC)-to-HDL ratio is effective as a prognostic indicator in various hyperlipidemia and endocrine diseases, which is significant since it is the first trial in dogs. Through a retrospective study design, sixteen client-owned dogs and cats visiting a local private practice were divided into three groups: five dogs without hyperlipidemia or metabolic disease (Group 1), eight dogs with Cushing’s, hypothyroidism, and gallbladder sludge (Group 2), and three cats, including one with diabetes, one with a urinary disorder, and one healthy cat (Group 3). In two dogs, the TC/HDL values were between 2 and 3; in two dogs, the values were between 3 and 4; and in two dogs, the values were between 4 and 5. In three dogs, the TC/HDL values were between 5 and 6 and in three dogs the ratio values were between 6 and 7. The other value was higher than 8. Except for two dogs that showed lower values than 3, all dogs in Group 1 and Group 2 had concurrent endocrine disease. This means that TC/HDL values can be an excellent indicator of endocrine disease in dogs as well. In cats, although it is a very small batch of samples, a high TC/HDL value of 9 points was shown in the cat that had diabetes mellitus. However, for more statistically significant results, a larger sample group for further investigation is needed.

Assessment of knowledge, attitude, practice and barriers of exclusive breastfeeding among nursing mothers in Makurdi Local Government Area of Benue State

Introduction: Over the years, breastfeeding has been a universal means of feeding infants and a common feature of all cultures since the survival of mankind. It is a phenomenon that is deeply rooted in the tradition of human culture. Although, breastfeeding practices have fluctuated over the years, it is widely regarded as an unequalled way of providing ideal nutrition for the healthy growth and development of infants. This study aims to assess the knowledge, attitude, practice and some barriers of exclusive breastfeeding among nursing mothers in Makurdi Local Government Area of Benue State. Method: This is a descriptive cross-sectional study to assess the knowledge, attitude, practice and barriers of nursing mothers towards Exclusive Breast Feeding (EBF). An interviewer-self-administered pretested questionnaire was used to collect data on maternal knowledge, Attitude, Practice and barriers of EBF. The modified Blooms criteria was adapted to grade knowledge, attitude and practice as either Good or poor. Statistical significance was considered at 95% confidence interval. Results: The results from this study showed that nursing Mother’s knowledge of EBF was good, 84.0% of the respondents displayed good knowledge of EBF, good attitude towards EBF was at 54.7% and the practice of EBF was 67.3%. Notable barriers to EBF includes, poor knowledge of EBF among nursing mothers (75.0%), followed by concurrent breast disease 6 months post-natal (66.7%), next was women who have never attended Antenatal Care Clinic (ANC) 62.5%. Conclusion: These findings suggest good knowledge and practice of EBF, however there is need to institute intervening measures aimed at reducing barriers associated with EBF in the study community.

Liver Resection With Extrahepatic Disease: A Population-Based Analysis of Thoughtful Selection.

The oncologic benefit of liver resection for colorectal liver metastases (CRLM) in the setting of concurrent extrahepatic disease (EHD) is controversial. We performed a population-based, cross-sectional study to determine the practice patterns and overall survival (OS) of patients with CRLM + EHD who underwent liver resection. Patients with CRLM + EHD were identified using the California Cancer Registry from 2000 to 2019. Records were linked to the Office of Statewide Health Planning Inpatient Database. Patient demographics, clinical characteristics, and survival were compared between CRLM + EHD patients with and without liver resection. Of 170 978 patients with CRLM, 62 003 (36%) had concurrent EHD (CRLM + EHD). In all, 3736 (6%) of CRLM + EHD underwent liver resection compared to 22% of patients with liver limited CRLM. Compared to CRLM + EHD without liver resection, CRLM + EHD with resection were younger, had fewer comorbidities, received higher frequencies of perioperative chemotherapy, and were more likely to have only a single site of EHD rather than multiple sites. Median OS was significantly higher for CRLM + EHD with resection compared to without (52 vs. 27 months, HR 0.46 [95% CI 0.44-0.47], p < 0.001). Regarding the location of EHD, this survival benefit was observed with liver resection for lung, peritoneal, intraabdominal lymph nodes, ovarian, and bone metastases. In a large population-based setting, subsets of CRLM + EHD patients that undergo liver resection are associated with prolonged survival. These results support surgery with thoughtful patient selection to optimize survival outcomes in this population.

Utilization of endovascular thrombectomy in patients with antiphospholipid syndrome and acute ischemic stroke

Abstract Background Antiphospholipid syndrome (APS) is a prothrombotic state and can cause acute ischemic stroke (AIS) particularly in younger individuals. Purpose Given the recent widespread adoption of endovascular thrombectomy (EVT) in patients with AIS, we aimed to evaluate the current trends and utilization of this technique in patients with APS. Methods We used National Readmission Database (NRD) to identify patients admitted between 2016 and 2020 with a primary diagnosis of AIS and a concurrent diagnosis of APS using relevant ICD-10 CM codes. Results Our analysis identified a total of 2,535,777 patients admitted for AIS, of which 7209 had a concomitant diagnosis of APS. The median age in patients with APS was 55 compared to 71 in non-APS patients (p &amp;lt; 0.001). APS patients also exhibited a lower prevalence of comorbidities such as coronary artery disease (4% vs. 28%; p &amp;lt; 0.001), congestive heart failure (CHF) (15% vs. 19%; p &amp;lt; 0.001), atrial fibrillation (14% vs. 26%), and diabetes (12% vs. 18%; p &amp;lt; 0.001). Systemic lupus erythematosus (SLE) was the most prevalent concurrent autoimmune disease in the APS cohort (19%). Patients with APS were significantly more likely to undergo EVT compared to their non-APS counterparts (5.2% vs. 3.5%; p &amp;lt; 0.001). Mortality was higher in non-APS likely due to older age compared to non-APS but didn’t reach statistical significance (4.4% vs 3.7%, p=0.070). Notably, the length of hospital stay was significantly higher for patients with APS (median: 6 days) compared to the non-APS group (median: 3 days; p &amp;lt; 0.001). Furthermore, we observed a steady increase in the utilization of EVT in patients with APS and AIS from 2016 (3.7%) to 2020 (6.8%; p = 0.02). Conclusion Our findings demonstrate that patients with AIS and concurrent APS are more likely to undergo endovascular thrombectomy, potentially due to a higher stroke burden. Additionally, the study revealed a progressive increase in the use of EVT for this specific patient population.

Clinical associations with thyroid disease in ANCA-associated vasculitis.

To evaluate the frequency and the clinical relevance of thyroid disease in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients. A total of 305 AAV patients admitted to the Second Affiliated Hospital of Chongqing Medical University between October 2010 and December 2023 were analyzed. Demographic, clinical, and laboratory data were compared between AAV patients with and without thyroid disease. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with thyroid disease in AAV patients. Among the 305 AAV patients, 52 (17.0%) had concurrent thyroid disease. In univariate analysis, gender, coronary artery disease, renal involvement, anti-Ro/SSA antibodies, anti-Ro52 antibodies, anti-thyroglobulin antibodies (TgAb), and anti-thyroid peroxidase antibodies (TPOAb) exhibited significant differences between AAV patients with and without thyroid disease (P < 0.05). Multivariate analysis revealed that female gender (odds ratio (OR) = 2.423, 95% confidence interval (95% CI) 1.241, 4.729; P = 0.009), concurrent coronary artery disease (OR = 2.998, 95% CI 1.280, 7.019; P = 0.011), and positive anti-Ro/SSA antibodies (OR = 4.697, 95% CI 1.960, 11.257; P = 0.001) were associated with thyroid disease in AAV patients. AAV patients have a higher incidence of thyroid disease. Regular monitoring of thyroid function is advised for AAV patients, particularly for women, those with coronary artery disease, and those who are positive for anti-Ro/SSA antibodies. Key Points • AAV patients have a higher incidence of thyroid disease. • The potential clinical relevance of AAV patients with thyroid disease was explored. • Regular monitoring of thyroid function is advised for AAV patients.

WNV and SLEV coinfection in avian and mosquito hosts: impact on viremia, antibody responses, and vector competence.

West Nile virus (WNV) and St. Louis encephalitis virus (SLEV) are closely related flaviviruses that can cause encephalitis in humans and related diseases in animals. In nature, both are transmitted by Culex, with wild birds, including jays, sparrows, and robins, serving as vertebrate hosts. WNV and SLEV circulate in the same environments and have recently caused concurrent disease outbreaks in humans. The extent that coinfection of mosquitoes or birds may alter transmission dynamics, however, is not well characterized. We therefore sought to determine if coinfection alters infection kinetics and virus levels in birds and infection rates in mosquitoes. Accordingly, American robins (Turdus migratorius), two species of mosquitoes, and vertebrate and invertebrate cells were infected with WNV and/or SLEV to assess how simultaneous exposure may alter infection outcomes. There was variable impact of coinfection in vertebrate cells, with some evidence that SLEV can suppress WNV replication. However, robins had comparable viremia and antibody responses regardless of coinfection. Conversely, in Culex cells and mosquitoes, we saw a minimal impact of simultaneous exposure to both viruses on replication, with comparable infection, dissemination, and transmission rates in singly infected and coinfected mosquitoes. Importantly, while WNV and SLEV levels in coinfected mosquito midguts were positively correlated, we saw no correlation between them in salivary glands and saliva. These results reveal that while coinfection can occur in both avian and mosquito hosts, the viruses minimally impact one another. The potential for coinfection to alter virus population structure or the likelihood of rare genotypes emerging remains unknown.IMPORTANCEWest Nile virus (WNV) and St. Louis encephalitis virus (SLEV) are closely related viruses that are transmitted by the same mosquitoes and infect the same birds in nature. Both viruses circulate in the same regions and have caused concurrent outbreaks in humans. It is possible that mosquitoes, birds, and/or humans could be infected with both WNV and SLEV simultaneously, as has been observed with Zika, chikungunya, and dengue viruses. To study the impact of coinfection, we experimentally infected vertebrate and invertebrate cells, American robins, and two Culex species with WNV and/or SLEV. Robins were efficiently coinfected, with no impact of coinfection on virus levels or immune response. Similarly, in mosquitoes, coinfection did not impact infection rates, and mosquitoes could transmit both WNV and SLEV together. These results reveal that WNV and SLEV coinfection in birds and mosquitoes can occur in nature, which may impact public health and human disease risk.

Concurrent Post-Zoster Cutaneous Vasculitis and Acute Calcium Pyrophosphate Deposition Disease (CPPD) in an Elderly Patient: A Case Report

Concurrent Post-Zoster Cutaneous Vasculitis and Acute Calcium Pyrophosphate Deposition Disease (CPPD) in an Elderly Patient: A Case Report

Elevated Trans-mitral Pressure Gradient Predicts Surgery in Young People with Moderate-Severe Rheumatic Mitral Regurgitation.

Mitral regurgitation (MR) is the most common lesion in children with rheumatic heart disease (RHD). Progression of RHD results in the need for surgical intervention, the timing of which is dictated by left ventricular dilatation and the onset of heart failure symptoms. We sought to determine whether elevation in trans-mitral pressure gradient (TMPG) in those with moderate or severe rheumatic MR without significant mitral stenosis (MS) could predict the need for future surgical intervention. Echocardiographic studies were reviewed for 116 children and young people with moderate or severe rheumatic MR. Those with significant mitral stenosis or concurrent aortic valve disease were excluded. Trans-mitral pressure gradient was measured at baseline and details of mitral valve surgical intervention were retrieved from a registry database. Time to future surgery (up to six years) was compared between those with TMPG < 5mmHg and TMPG ≥ 5mmHg. Survival curves demonstrated an increased risk of surgery for those with TMPG ≥ 5mmHg with Cox proportional regression analysis providing a hazard ratio of 5.8. The proportion free from mitral valve surgery at one year for the TMPG < 5mmHg group was 0.94 (95% CI 0.86-0.97), compared to 0.62 (95% CI 0.42-0.77) in the ≥ 5mmHg group. Trans-mitral pressure gradient is a strong predictor of future mitral valve surgery in children and young people with significant rheumatic MR without MS. This non-invasive measure could be used to signal the need for more aggressive monitoring in order to optimize the timing of intervention.

Myeloid sarcomas with CBFA2T3 : GLIS2 fusion: clinicopathologic characterization of 4 cases mimicking small round cell tumors.

Acute myeloid leukemia with CBFA2T3::GLIS2 fusion can initially present as extramedullary lesions (myeloid sarcoma), leading to a misdiagnosis of nonhematologic pediatric solid tumors. We characterized the clinicopathologic features of 4 cases of CBFA2T3::GLIS2 fusion-positive myeloid sarcoma in pediatric patients where the sarcoma presented either without leukemic involvement (isolated myeloid sarcoma; 3/4 [75%]) or had concurrent leukemic disease (1/4 [25%]). All cases mimicked nonhematopoietic tumors at morphologic and immunophenotypic levels, so the initial evaluation did not raise suspicion for acute myeloid leukemia/myeloid sarcoma. After extensive workup, however, including molecular studies, the diagnosis of myeloid sarcoma with CBFA2T3::GLIS2 fusion was rendered. This study highlights the need for a high suspicion index of GLIS2-rearranged myeloid sarcoma in the differential diagnosis of pediatric small round cell tumors in tissue biopsies and the application of adequate workup to avoid misdiagnosing this entity.

Concurrent chronic kidney disease in patients with inflammatory bowel disease, a systematic review and meta-analysis.

Inflammatory bowel disease (IBD) is a multi-organ autoimmune disease that commonly affects the gastrointestinal tract, but can also affect other organs throughout the body. Less is known, however, about kidney involvement in IBD. Although IBD has been associated with chronic kidney disease (CKD) and end-stage renal disease (ESRD), these results have been inconsistent. The present study analyzed the prevalence of concurrent CKD and ESRD in patients with IBD. PubMed, Cochrane, Web of Science, and Embase were searched for studies published through October 2023 on IBD patients with concurrent CKD or ESRD. Outcomes included the incidence rates and odds ratios (OR) of concurrent CKD and ESRD in IBD patients. The quality of included studies was assessed using the Newcastle-Ottawa Scale, and sequential sensitivity was analyzed. Publication bias was evaluated using Egger's test. Nine studies were included in this meta-analysis. The combined results of eight studies, which included 239,042 IBD patients, showed that the prevalence of CKD in IBD patients was 5% (95% confidence interval [CI]: 1-9%). The combined results of two studies, which included 40,341 IBD patients, showed that the prevalence of ESRD in IBD patients was 0.2% (95% CI: -0.08-0.12%). The combined results of six case-control studies reported that the risk of CKD was significantly higher in patients with than without IBD (OR 1.36, 95% CI: 1.08-1.70, p = 0.008). Although studies have shown an increased risk of CKD in IBD, due to the small number of included studies and high heterogeneity across studies, it is not enough to definitively conclude that CKD is more common in patients with IBD. But patients with IBD should be regularly monitored for CKD. https://www.crd.york.ac.uk/PROSPERO/.

S1236 Primary Sclerosing Cholangitis: Evaluating Colorectal Cancer Risk With and Without Concurrent Inflammatory Bowel Disease

S1236 Primary Sclerosing Cholangitis: Evaluating Colorectal Cancer Risk With and Without Concurrent Inflammatory Bowel Disease

Alzheimer's disease clinical variants show distinct neuroinflammatory profiles with neuropathology.

Although the neuroanatomical distribution of tau and amyloid-β is well studied in Alzheimer's disease (AD) (non)-amnestic clinical variants, that of neuroinflammation remains unexplored. We investigate the neuroanatomical distribution of activated myeloid cells, astrocytes, and complement alongside amyloid-β and phosphorylated tau in a clinically well-defined prospectively collected AD cohort. Clinical variants were diagnosed antemortem, and brain tissue was collected post-mortem. Typical AD (n= 10), behavioural/dysexecutive AD (n= 6), posterior cortical atrophy (PCA) AD (n= 3), and controls (n= 10) were neuropathologically assessed for AD neuropathology, concurrent pathology including Lewy body disease, limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC), and vascular pathology. For quantitative assessment, we analysed the corticolimbic distribution of phosphorylated tau, amyloid-β, CD68, MHC-II, C4b, and glial fibrillary acidic protein (GFAP) using digital pathology. Phosphorylated tau was distinctly distributed in each variant. In all variants, amyloid-β was neocortical-dominant, with a notable increase in the middle frontal cortex of behavioural/dysexecutive AD. Typical AD and PCA AD had no concurrent Lewy body disease, whereas three out of six cases with behavioural/dysexecutive AD did. LATE-NC stage >0 was observed in three AD cases, two typical AD (stage 1/3), and one behavioural/dysexecutive AD (stage 2/3). Vascular pathology was present in each variant. In typical AD, CD68 and MHC-II were hippocampal-dominant. In behavioural/dysexecutive AD, C4b was elevated in the middle frontal and inferior parietal cortex. In PCA AD, MHC-II was increased in the fusiform gyrus, and GFAP in parietal cortices. Correlations between AD neuropathology and neuroinflammation were distinct within variants. Our data suggests that different involvement of neuroinflammation may add to clinical heterogeneity in AD, which has implications for neuroinflammation-based biomarkers and future therapeutics.

Positive rate of canine pancreatic lipase immunoreactivity (SNAP cPL) in relationship with severity of clinical signs and concurrent disorders: a retrospective study

Acute pancreatitis (AP) is a common disorder characterized by the inflammation of the exocrine pancreas in dogs, and the severity of the clinical signs of pancreatitis varies greatly. Therefore, the diagnosis of pancreatitis is challenging. The canine pancreatic lipase immunoreactivity test (SNAP cPL; IDEXX Laboratories Inc., USA) is rapid and relatively accurate in diagnosing pancreatitis. The purpose of this study was to evaluate the positivity rate of the SNAP cPL test in dogs regarding the severity of gastrointestinal (GI) signs and concurrent diseases. Electronic medical records of dogs were reviewed. For retrospective classification, 80 dogs with GI signs who underwent the SNAP cPL test were enrolled. Additionally, concurrent diseases on the day of the SNAP cPL test were reviewed. A positive SNAP cPL test result was observed in 26 of the 80 dogs (32.5%) with GI signs. The severity of GI signs using a scoring system and the positivity rate of SNAP cPL were statistically related. Furthermore, dogs with concurrent chronic kidney disease had a significantly higher positivity rate of SNAP cPL than those without chronic kidney disease. This information might help clinicians to decide whether a SNAP cPL test is needed.