Early Functional Changes Research Articles

Effect of breathing exercises with biofeedback on blood pressure in pre-hypertensive women: a randomised controlled trial

IntroductionPre-hypertensive women are significantly more likely to develop hypertension or serious cardiovascular disease (CV). Autonomic nervous system abnormalities, such as sympathetic overactivity and parasympathetic withdrawal, are most likely the earliest functional changes in hypertension. The objective of this study was to determine the effect of breathing exercises with biofeedback on blood pressure (BP), heart rate variability (HRV), respiratory rate (RR), and skin galvanic response (SGR).MethodsThirty middle-aged women with pre-hypertension (120/80–139/89 mm Hg) were recruited from Ain Shams University. They were divided randomly into two equal groups, with ages ranging from 30 to 40: study group (group A) who performed slow abdominal breathing (six cycles/minute) combined with frontal electromyography (EMG) biofeedback training (3 days per week for 10 sessions) and a control group (group B) who performed slow abdominal breathing (six cycles/minute, 3 days per week for 10 sessions). All subjects were assessed by measuring systolic blood pressure (SBP), diastolic blood pressure (DBP), HRV, RR, and SGR levels before and after the intervention.ResultsSBP, DBP, RR, and SGR mean values showed a statistically significant decline; however, Group A’s HRV post-treatment increased significantly compared to pre-treatment (<i>p</i> = 0.001). In Group B, there was no significant difference in DBP or SGR; however, there was a substantial drop in SBP and HRV (<i>p</i> = 0.001) and a significant rise in RR (<i>p</i> = 0.001). Following therapy, there was a significant difference between the two groups in terms of DBP, HRV, RR, and SGR (<i>p</i> = 0.001), favouring group A.ConclusionsAs a result, it is possible to infer that breathing exercises combined with biofeedback were beneficial in lowering BP in middle-aged pre-hypertensive women.

Elucidating Early Radiation-Induced Cardiotoxicity Markers in Preclinical Genetic Models Through Advanced Machine Learning and Cardiac MRI

Radiation therapy (RT) is widely used to treat thoracic cancers but carries a risk of radiation-induced heart disease (RIHD). This study aimed to detect early markers of RIHD using machine learning (ML) techniques and cardiac MRI in a rat model. SS.BN3 consomic rats, which have a more subtle RIHD phenotype compared to Dahl salt-sensitive (SS) rats, were treated with localized cardiac RT or sham at 10 weeks of age. Cardiac MRI was performed 8 and 10 weeks post-treatment to assess global and regional cardiac function. ML algorithms were applied to differentiate sham-treated and irradiated rats based on early changes in myocardial function. Despite normal global left ventricular ejection fraction in both groups, strain analysis showed significant reductions in the anteroseptal and anterolateral segments of irradiated rats. Gradient boosting achieved an F1 score of 0.94 and an ROC value of 0.95, while random forest showed an accuracy of 88%. These findings suggest that ML, combined with cardiac MRI, can effectively detect early preclinical changes in RIHD, particularly alterations in regional myocardial contractility, highlighting the potential of these techniques for early detection and monitoring of radiation-induced cardiac dysfunction.

Application of functional magnetic resonance imaging to evaluate renal structure and function in type 2 cardiorenal syndrome

BackgroundThere is a lack of diagnostic non-invasive imaging technology for assessing the early structural and functional changes of the kidney in type 2 cardiorenal (CRS) patients. This study aims to explore the value of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for clinical application in type 2 CRS patients, to provide imaging markers for the assessment of kidney damage.MethodsThis is a retrospective observational clinical study conducted in Nanjing, China. The clinical characteristics, including age, gender, medical history, laboratory results, and ultrasound and magnetic resonance imaging results were collected from the electronic medical record. Thirty-one patients with type 2 CRS, 20 patients with chronic heart failure (HF) and 20 healthy controls were enrolled and divided into type 2 CRS, HF and control groups. All the participants underwent magnetic resonance imaging (MRI) scanning. The apparent diffusion coefficient (ADC) value and IVIM-DWI parameters including true diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) were obtained. The correlation between estimated glomerular filtration rate (eGFR), renal size and imaging parameters was evaluated by Spearman correlation analysis.ResultsADC and D of the renal cortex in patients with type 2 CRS were lower than those in the healthy control group. ADC and f in the HF group were lower than those in the control group. D was positively correlated with the length (r = 0.3752, P = 0.0013) and transverse diameter (r = 0.3258, P = 0.0056) of the kidney. ADC (r = 0.2964, P = 0.0121) and D (r = 0.3051, P = 0.0097) were positively correlated with eGFR. Renal cortical ADC and D values could distinguish type 2 CRS patients from the healthy controls with area under the curve (AUC) of 0.723 and 0.706, respectively.ConclusionThe ADC and D values were not only correlated with renal function, but also had lower levels in type 2 CRS. The IVIM-DWI parameter D was also related to kidney size, but further research is needed to determine whether it can be used as a novel imaging marker for type 2 CRS.

Kidney hyperfiltration and mitochondrial changes are associated with eGFR decline in young people with type 1 diabetes.

To examine the relationship between kidney hyperfiltration during adolescence and subsequent changes in estimated glomerular filtration rate (eGFR) and urinary albumin creatinine ratio (UACR) in a young cohort of participants with type 1 diabetes. Additionally, to explore urinary mitochondrial DNA:nuclear DNA ratio (mtDNA:nDNA) as a marker of metabolic stress and its association with early changes in kidney function. Eighty adolescents were studied at baseline [mean (SD) age 14.2 (1.5) years; mean diabetes duration 6.7 (3.0) years] and followed up 9.2 (1.3) years later. Blood pressure, HbA1c, lipids, eGFR, UACR and heart rate variability were assessed at each visit. Urinary mtDNA:nDNA was measured by quantitative PCR (qPCR). Overall, 4.2% of participants had diabetic kidney disease (DKD) at follow-up. Hyperfiltration at baseline (>135 mL/min/1.73m2) was seen in 31% of adolescents and was associated with a decline in eGFR at follow-up when adjusted for sex, diabetes duration and HbA1c [hyperfiltration -1.46 (3.07) mL/min/1.73 m2/year vs non-hyperfiltration -0.51 (2.48) mL/min/1.73m2/year, P=0.02]. Participants with hyperfiltration also had higher odds of undergoing rapid eGFR decline (>3 mL/min/1.73m2/year) compared to those without hyperfiltration [OR 14.11, 95% CI (2.30-86.60), P=0.004]. Baseline urinary mtDNA:nDNA was significantly associated with both greater annual rate of eGFR decline and rapid eGFR decline in univariable but not multivariable modelling. Hyperfiltration during adolescence is significantly associated with greater reduction in eGFR and higher risk of rapid eGFR decline after ∼9 years, following transition into young adulthood in type 1 diabetes. Urinary mtDNA:nDNA measured during adolescence may be a novel predictor of early changes in kidney function.

Gastrointestinal Issues in Depression, Anxiety, and Neurodegenerative Diseases: A Systematic Review on Pathways and Clinical Targets Implications.

Multiple illnesses commonly involve both the Central Nervous System (CNS) and the Gastrointestinal Tract (GI) simultaneously. Consistent evidence suggests that neurological disorders impair GI tract function and worsen the symptomatology and pathophysiology of digestive disorders. On the other hand, it has been proposed that early functional changes in the GI tract contribute to the genesis of several CNS illnesses. Additionally, the role played by the gut in these diseases can be seen as a paradigm for how the gut and the brain interact. We mentioned significant GI symptoms and discussed how the GI tract affects central nervous system illnesses, including depression, anxiety, Alzheimer's disease, and Parkinson's disease in this study. We also explored potential pathophysiological underpinnings and novel targets for the creation of future therapies targeted at gut-brain connections. In this situation, modulating the gut microbiota through the administration of fecal microbiota transplants or probiotics may represent a new therapeutic option for this population, not only to treat GI problems but also behavioral problems, given the role that dysbiosis and leaky gut play in many neurological disorders. Accurate diagnosis and treatment of co-existing illnesses also require coordination between psychiatrists, neurologists, gastroenterologists, and other specialties, as well as a thorough history and thorough physical examination.

Left atrial longitudinal strain behavior in patients with cryptogenic stroke - a case control study

Abstract Background A significant percentage of ischemic strokes classified as cryptogenic stroke (CS) where the definition is varied according to the type of classification used. Left atrial (LA) function has a role in determining the possible cardio-embolic source of stroke. Using speckle tracking transthoracic echocardiography (TTE) we can detect the early changes in left atrial function by measuring left atrial longitudinal strain (LALS). Aim To evaluate the left atrial stain in patients with a cryptogenic stroke as compared to a healthy papulation. Method and results We recruited 50 cryptogenic ischemic stroke patients with mean age of 44.7 years and 50 % were male who treated consecutively as for first CS, and 50 age-and sex-matched healthy stroke-free controls. Using Speckle tracking TTE analysis we measured the global , passive and active longitudinal LA strain corresponding to the reservoir (LASRES), conduit(LASCD), and contractile function(LASCT),respectively in addition to standard other LA parameters and filling pressure parameters of Left ventricle(LV) in both group. Data were compared using t-test and Mann-Whitney test. Cryptogenic stroke patients as compared with controls had significantly reduced value of all components of LALS [Mean value of LASRES, LASCD and LASCT in CS group versus control group were 25.15±6.79 versus 43.95±4.62 (P-value <0.01), 14.41±3.53 versus 25.68±3.30 (P- value <0.01), 10.73±3.35 versus 18.28±1.60 (P-value <0.01) respectively] (Figure 1 and Figure 2). There were no significant differences in means of LA area and LA volume index in both groups (P value >0.05). Between parameters of LV filling pressures, it was noticed that early diastolic transmitral flow velocity (E) and early diastolic velocity at annulus (E’) were statistically lower in CS patients as compared to control group (P-value <0.01). In addition, the Cluster and Discriminant analysis used confirmed that LASRES, LASCD and LASCT were significantly lower in value in cryptogenic stroke patients in comparison to Control group which can be used to detect early LA dysfunction. Conclusion LA longitudinal strain in all components were significantly impaired in patients with CS. Measuring LALS parameters can be useful in determining early LA dysfunction in cryptogenic stroke patients.Figure 1-left atrial strain components.Figure 2 -left atrial strain component.

Establishing Normative Values of Peak Expiratory Flow Rates in the Paediatric Population in Jharkhand.

Background The peak expiratory flow rate (PEFR) is the maximum flow rate (expressed as L/s) generated during a forceful exhalation, starting from full inspiration. It is an effort-dependent parameter and reflects large airway flow. It depends on lung recoil, muscular strength of patients, and voluntary effort. The PEFR is a simple and easy way to detect early changes in lung function. The PEFR can be measured by a peak flow meter or a spirometer; however, a spirometer is more accurate than a peak flow meter. The PEFR is known to vary according to age, gender, and anthropometric parameters like height, weight, BMI, ethnicity, and altitude. PEFR values for different populations are needed because they helpto determine the variable expiratory flow limitation in asthma. There is no study done to find out the normal PEFR in children in Jharkhand. Hence, this studyaimed to establish the reference values of the PEFR of children in Jharkhand. Methodology Three hundred and sixteen healthy children belonging to the age group of 6-18 years attending the OPD of Rajendra Institute of Medical Sciences, Ranchi were studied. All the children were asked to perform spirometry, and the PEFR was recorded. Patient demographic details like age, sex, height, weight, BMI, and ethnicity were documented. These factors were selectedto see how the PEFR of children in Jharkhand correlated with them and compare it with the values obtained from similar studies conducted in different parts of India. Results Three hundred and sixteen children were studied, consisting of 194 male participants and 122 female participants. The mean PEFR for maleparticipantswas 3.90±1.58L/s and for female participants, it was 4.04±1.49L/s. The correlation coefficient of the PEFR with height was 0.792, that of the PEFR with weight was 0.713 and that of the PEFR with BMI was 0.364. Hence, height is the best predictor of PEFR. The lowest correlation of BMI with PEFR shows that the recent rise in obesity in the paediatric population should not be expected to affect the lung function significantly. Conclusion The mean PEFR of children in Jharkhand is lower than that of children in northern (mean PEFR of maleparticipants=4.41 ± 1.54 L/s, mean PEFR of female participants = 4.17 ± 1.17 L/s) and southern India (mean PEFR of maleparticipants=4.88±1.29 L/s, mean PEFR of female participants = 4.25±1.29 L/s). Compared to neighbouring states in eastern India, the mean PEFR of children in Jharkhand is lower.

A NEW PERSPECTIVE ON DIAGNOSIS: THE POTENTIAL OF CT PERFUSION IN CHRONIC LIVER DISEASE (LITERATURE REVIEW)

The aim of this study is to analyze the current advances of CT perfusion in the diagnosis of liver disease. Liver fibrosis is a characteristic feature of chronic liver disease and is confirmed by liver biopsy, which is an invasive method. Morphologic parameters of cirrhosis are evaluated by conventional imaging techniques such as ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). Additional studies of new imaging modalities are needed for earlier diagnosis, surveillance and accurate treatment, CT perfusion has several advantages by examining the arterial and venous blood flow of the liver, which gives a more complete picture of early functional changes in the liver. Despite the advantages of this method, the results of postprocessing in different stages of fibrosis and etiology of its development are not fully understood.

Concurrent Validity of Performance-Based Measures of Daily Functioning with Cognitive Measures and Informant Reported Everyday Functioning.

Despite the substantial need for reliable and valid assessment of functional ability in older adults, there is currently limited research on the emergence of early functional declines during prodromal dementia stages, such as subjective cognitive decline (SCD) and mild cognitive impairment (MCI). This study uses novel performance-based assessments to characterize subtle, yet clinically meaningful, changes in functional ability. A sample of 93 older adults classified as cognitively unimpaired (CU; n = 30, Mage = 73.57 ± 6.66), SCD (n = 34, Mage = 72.56 ± 6.43), or MCI (n = 29, Mage = 78.28 ± 7.55) underwent neuropsychological testing along with an informant-rated daily functional skills measure (Assessment of Functional Capacity Interview). Participants also completed the Night Out Task (NOT), an open-ended performance-based measure of functional assessment, and the Financial Capacity Instrument-Short Form (FCI-SF) that assesses financial skills. The MCI group performed worse on the NOT and FCI-SF relative to SCD and CU. NOT and FCI scores were associated with measures of global cognitive function, executive function, processing speed, language and memory, and FCI-SF overall score was correlated with informant-rated functional ability. The NOT and FCI-SF were also predictive of informant-reported daily functioning over and above traditional cognitive data and demographics. Performance-based measures of IADL may allow for earlier detection of subtle functional changes that might not be adequately captured by traditional measures. The measurement of early functional changes is an important global outcome to evaluate the efficacy of interventions in dementia research.

Innovative study of the fetal heart in monochorionic multiple births

Introduction. Fetal echocardiography is currently one of the main methods of prenatal diagnosis. However, in recent years, attention has shifted towards the use of ultrasound to assess fetal myocardial function.The aim of this study is compare global longitudinal deformation of the myocardium of the left (LV) and right ventricles (RV) of the heart in fetuses with uncomplicated singleton pregnancy, in fetuses from monochorionic twins with transfusion syndrome, selective growth retardation and in uncomplicated monochorionic multiple pregnancy.Material and methods. A prospective cohort study was conducted which included 60 pregnant patients: Group I — patients with an uncomplicated singleton pregnancy (n=25); Group II — 35 patients with monochorionic diamniotic twins, whose pregnancy in 10 cases was complicated by feto-fetal transfusion syndrome (stages I-III according to Quintero R.A.), in 10 cases — selective growth retardation of the second fetus and in 15 cases monochorionic twins without complications. The following parameters were determined: global longitudinal deformation (GLD) of the myocardium of the ventricles of fetal hearts using the speckle tracking method of ejection fraction (EF), end-diastolic and end-systolic volumes of the ventricles of the heart.Results. Significant differences were established in GLD of RV and LV between singleton and monochorionic multiple pregnancies (LV: -21.2 ± 2.03 versus -23.41 ± 0 .25, p = 0.003); RV: — 20.3 ± 2.5 versus -23.3 ± 2.5, p = 0.013). Significant differences were revealed in GLD of the LV and RV in recipient fetuses before and after laser coagulation of placental anastomoses (LPCA) [LV in recipients before LCPA (- 20.4 ± 2.98) versus LV recipient after LCPA (-24.2 ± 3.3), p = 0.018], [RV in recipients before LKPA (- 20.4 ± 2.8) vs. RV in recipients after laser coagulation of placental anastomoses (-23.7 ± 3.4, p = 0.012].Conclusion. Assessment of the cardiac function of fetuses from monochorionic twins using the echocardiographic speckle tracking technique makes it possible to identify early changes in fetal myocardial function in twins from monochorionic diamniotic twins, as well as to carry out reliable testing monitoring changes in cardiac function over time.

Morphological comparison of astrocytes in the lamina cribrosa and glial lamina.

Although the mechanisms underlying glaucomatous neurodegeneration are not yet well understood, cellular and small animal models suggest that LC astrocytes undergo early morphologic and functional changes, indicating their role as early responders to glaucomatous stress. These models, however, lack the LC found in larger animals and humans, leaving the in situ morphology of LC astrocytes and their role in glaucoma initiation underexplored. In this work, we aimed to characterize the morphology of LC astrocytes in situ and determine differences and similarities with astrocytes in the mouse glial lamina (GL), the analogous structure in a prominent glaucoma model. Astrocytes in the LCs of twenty-two eyes from goats, sheep, and pigs were stochastically labeled via Multicolor DiOlistics and imaged in situ using confocal microscopy. 3D models of DiOlistically-labeled LC astrocytes and hGFAPpr-GFP mouse GL astrocytes were constructed to quantify morphological features related to astrocyte functions. LC and GL astrocyte cross-pore contacts, branching complexity, branch tortuosity, and cell and branch span were compared. LC astrocytes displayed distinct spatial relationships with collagen, greater branching complexity, and higher branch tortuosity compared to GL astrocytes. Despite substantial differences in their anatomical environments, LC and GL astrocytes had similar cell and branch spans. Astrocyte morphology in the LC was characterized through Multicolor DiOlistic labeling. LC and GL astrocytes have both distinct and shared morphological features. Further research is needed to understand the potentially unique roles of LC astrocytes in glaucoma initiation and progression.

Differences in Grey Matter Concentrations and Functional Connectivity between Young Carriers and Non-Carriers of the APOE ε4 Genotype.

Background: The pathophysiology of Alzheimer's disease (AD) may begin developing years or even decades prior to the manifestation of its first symptoms. The APOE ε4 genotype is a prominent genetic risk for AD that has been found to be associated with brain changes across the lifespan since early adulthood. Thus, studying brain changes that may occur in young adults with an APOE ε4 status is highly relevant. Objective: Examine potential differences in grey matter (GM) and functional connectivity (FC) in brains of cognitively healthy young APOE ε4 carriers and non-carriers, denoted here as ε4(+) and ε4(-), respectively. Methods: Three Tesla magnetic resonance imaging (MRI) brain scans were acquired from cognitively healthy young participants aged approximately 20 years (n = 151). Voxel-based morphometry (VBM) analysis was employed to identify potential structural differences in GM between ε4(+) and ε4(-). In a subsequent seed-based connectivity (SBC) analysis, brain regions that structurally differed in the VBM analysis were considered as seeds and correlated with all the remaining voxels across the brains to then measure the differences in FC between groups. Results: The VBM analysis suggested that ε4(+) (n = 28) had greater GM densities relative to ε4(-) (n = 123) in the left hippocampus and the left posterior insula (puncorr < 0.001). However, the effect did not survive the correction for multiple comparisons, suggesting minimal structural differences in this age range. In contrast, the SBC analysis indicated that ε4(+) exhibited significantly decreased FC between the left hippocampus and areas of the left middle temporal gyrus (n = 27) compared to ε4(-) (n = 102). These results remained significant after multiple comparisons (pFDR < 0.05). Lastly, no statistically significant differences in FC between groups were observed for the left insular seed (pFDR > 0.05). Discussion: These results suggest early structural and functional brain changes associated with the APOE ε4 genotype on young adults. Yet, they must be cautiously interpreted and contrasted with both older adults with genetic risk for AD and patients diagnosed with AD.

P5: PREMATURE FUNCTIONAL DECLINE IN WOMEN OVER 40 YEARS OF AGE

Introduction: Early functional changes in women compromise elements such as muscle mass and strength, physical function, and gait speed, leading to a physiological decline that may contribute to frailty in old age.Objectives: This study aimed to relate strength and physical performance to premature functional decline in women aged 40 years and older.Methods: A cross-sectional descriptive observational study was conducted, and two groups of women were contrasted (40 to 60 years old and 60 and over), completing a sample of 31 women. Functional decline, lower limb muscle power, prehensile strength, physical performance, gait speed, phenotype of frailty status, level of physical activity, and other sociodemographic factors were contrasted. The UCT internal ethicscommittee.Results: Preliminary results showed that, among the demographic variables, women over 60 had a lower level of schooling, with 29% having incomplete basic education. Both groups reported a similar number of children: 93% in those under 60 and 100% in those over 60, with an average of 2.3 and 3.06 children, respectively. Statistically significant differences were detected in physical performance, lower limb strength, and gait speed, which were higher in women under 60.Conclusions: The present report detected that lower limb strength, a determinant of great relevance in the aging population, affects gait speed. Likewise, muscle strength leads to a more rapid decline in older people. In both groups, physical performance played a crucial role in characterizing aging and frailty, particularly at ages over 60, when a decline in performance was evident. Notably, there were no variations in grip strength or physical activity levels, possibly because both groups performed poorly, raising the possibility of functional decline in women who have not yet reached old age.

Echocardiographic strain imaging in the pediatric heart: clinical value and utility in decision making.

Speckle tracking echocardiography (STE)-derived measures of myocardial mechanics, referred to herewithin as strain measurements, directly assess myocardial contractility and provide a nuanced assessment of ventricular function. This review provides an overview of strain measurements and their current clinical value and utility in decision making in pediatric cardiology. Strain measurements are advancing understanding of how cardiac dysfunction occurs in children with acquired and congenital heart disease (CHD). Global strain measurements can detect early changes in cardiac function and are reliable methods of serially monitoring systolic function in children. Global strain measurements are increasingly reported in echocardiographic assessment of ventricular function alongside ejection fraction. Research is increasingly focused on how strain measurements can help improve clinical management, risk stratification, and prognostic insight. Although more research is needed, preliminary studies provide hope that there will be clinical benefit for strain in pediatric cardiology management. Strain measurements provide a more detailed assessment of ventricular function than conventional measures of echocardiographic functional assessment. Strain measurements are increasingly being used to advance understanding of normal and abnormal myocardial contractility, to increase sensitivity to detect early cardiac dysfunction, and to improve prognostic management in children with acquired and CHD.

Evaluation of left ventricular systolic function in patients with iron deficiency anemia based on non-invasive left ventricular pressure–strain loops

BackgroundIron deficiency anemia (IDA) is a common health problem worldwide. The objective of this study was to noninvasively and quantitatively evaluate early changes in left ventricular systolic function in patients with IDA using the left ventricular press–strain loop (LV-PSL).MethodsSixty-two patients with IDA were selected and divided into two groups based on hemoglobin (Hb) concentration: Group B with Hb > 9 g/dL and group C with 6 g/dL < Hb < 9 g/dL. Thirty-three healthy individuals were used as the control (Group A). The global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global waste work (GWW), global work efficiency (GWE) were derived using LV-PSL analysis. Receiver operating characteristic (ROC) curves were constructed for MW parameters to detect abnormal left ventricular systolic function in IDA patients.ResultsCompared to group A, GWI and GCW were reduced in group B (both P < 0.01). Compared with groups B and A, GLS, GWI, GCW and GWE, and E/A were all diminished, and GWW, LVEDV, LVESV, and E/mean e’ were all increased in group C (all P < 0.01). GLS was positively correlated with GWI, GCW, and GWE (r = 0.679, 0.681, and 0.447, all P < 0.01), and negatively associated with GWW (r = − 0.411, all P < 0.01). For GWI, area under the ROC curve (AUROC) was 0.783. The optimal GWI threshold for detecting abnormal LV systolic function in IDA was1763 mmHg%, with sensitivity of 0.71 and specificity of 0.78.ConclusionsLV-PSL allows noninvasive quantitative assessment of early impaired LV systolic function in IDA patients with preserved LV ejection fraction, and GWI has high sensitivity and specificity compared with other parameters.

Diffusion-weighted Imaging: New Paradigm in Diagnosis of Early Acute Pancreatitis.

Diffusion-weighted imaging (DWI) has come up as a newer diagnostic modality for the diagnosis of early functional changes in various organs including the pancreas. DWI has shown the ability of early and accurate diagnosis of inflammatory pathologies, before the appearance of morphological changes on imaging. The objectives of this study were to study the diagnostic accuracy of DWI in the diagnosis of early acute interstitial pancreatitis. The present retrospective observational study was conducted at the department of radiodiagnosis of a tertiary teaching hospital for 1 year. Fifty patients who underwent magnetic resonance imaging of the pancreas with clinical or laboratory diagnosis of early pancreatitis were included in the study. The diagnostic accuracy of DWI was analyzed on the basis of quantitative (apparent diffusion coefficient [ADC] values) evaluation in the diagnosis of early acute pancreatitis. Threshold values for ADC were derived for differentiation of inflamed versus normal pancreas. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) were obtained by drawing the receiver operating characteristic (ROC) curve. The mean ADC values in the patient group (0.882 × 10 -3 mm 2 /s ± 0.102) were significantly lower than the control group (1.178 × 10 -3 mm 2 /s ± 0.232) with P < 0.001. The ROC curve deciphered a cutoff value of 0.937 × 10 -3 mm 2 /s with a sensitivity of 84%, specificity of 86%, PPV of 85.71%, and NPV of 84.31% for diagnosis of acute pancreatitis using quantitative ADC values. DWI can thus be a succinct modality for early diagnosis of pancreatitis with excellent diagnostic accuracy and superlative advantage of lack of contrast and radiation in comparison to computed tomography scan.

2200 Association between gait speed deterioration and EEG abnormalities

Abstract Introduction Physical and cognitive decline at an older age is preceded by changes that accumulate over time until they become clinically evident difficulties. These changes, frequently overlooked by patients and health professionals, may respond better than fully established conditions to strategies designed to prevent disabilities and dependence in later life. The objective of this study was twofold: to provide further support for the need to screen for early functional changes in older adults and to look for an early association between decline in mobility and cognition. Methods A cross-sectional cohort study was conducted on 95 active functionally independent community-dwelling older adults in Havana, Cuba. We measured their gait speed at the usual pace and their cognitive status using the MMSE. A value of 0.8 m/s was used as the cut-off point to decide whether they presented a decline in gait speed. A quantitative analysis of their EEG at rest was also performed to look for an associated subclinical decline in brain function. Results Results show that 70% of the sample had a gait speed deterioration (i.e. lower than 0.8 m/s), of which 80% also had an abnormal EEG frequency composition for their age. While there was no statistically significant difference in the MMSE score between participants with a gait speed above and below the selected cut-off, individuals with MMSE scores below 25 also had a gait speed&amp;lt;0.8 m/s and an abnormal EEG frequency composition. Conclusions Our results provide further evidence of early decline in older adults – even if still independent and active - and point to the need for clinical pathways that incorporate screening and early intervention targeted at early deterioration to prolong the years of functional life in older age.

Abstract Mo025: Noninvasive cardiac phenotyping in patients treated with chemo- and immunotherapy for breast cancer

Current breast cancer diagnosis and treatment protocols achieve survival rates of&gt;80% at 10 years.However, long-term cancer survivors have&gt;4-fold higher incidence of cardiovascular complications, including heart failure.Early potentially reversible changes that may underlie downstream irreversible loss of mechanical function are unknown.Therefore, we aimed to test the feasibility of a noninvasive cardiac phenotyping protocol in patients undergoing treatment for breast cancer with doxorubicin, without or with immune checkpoint inhibitors, including multiparametric proton cardiac magnetic resonance(CMR) imaging and novel metabolic carbon13MR. A comprehensive set of studies included conventional 1HCMR,as well as metabolic 13CCMR using hyperpolarized(HP)[1-13C] pyruvate, following an oral glucose load. 13CCMR with HP[1-13C] pyruvate allows the detection of downstream metabolites of injected pyruvate within the myocardium: bicarbonate from mitochondrial oxidation and lactate from anaerobic cytosolic metabolism.HP[1-13C]pyruvate was prepared using dynamic nuclear polarization in a commercial polarizer.Imaging and spectroscopy(MRS) of hyperpolarized pyruvate was conducted using a 13C transmit/receive Helmholtz loop-pair coil on a 3Tscanner.13C data were acquired from a short-axis slice, ECG-triggered in end-systole. ProtonCMR images were analyzed using Circle, and 13CCMR images were analyzed using MATLAB. The left ventricular mid-myocardium and blood pool were segmented for metabolite quantitation. Baseline cardiac studies were performed in a consecutive series of 25 women treated for breast cancer. Of these 14(56%) were Caucasian, 3(12%) were Hispanic, 5(20%) Black, and 3(12%) Asian, with ages ranging 46±11 years.Patients received standard-of-care treatment plans based on the tumor type: 11 patients were treated with dose-dense anthracycline and cyclophosphamide, and 14 also received pembrolizumab. The comprehensive baseline phenotyping protocol is planned to be repeated after standard of care therapy in all patients. Baseline data are presented in Table1, with values reported as mean±standard deviation. Noninvasive cardiac phenotyping, including dynamic detection of metabolic substrate utilization is feasible,without showing significant adverse effects,and is well tolerated in a diverse group of patients.Completion of this protocol post-oncological therapy may allow to detect early changes in cardiac function due to chemo-and immunotherapy in susceptible patients.

Impact of maternal diabetes mellitus on fetal atrial strain.

While Maternal Diabetes Mellitus (DM) is well known to affect the size and function of multiple fetal organ systems, effects on developing heart chamber function remain difficult to assess. We sought to determine the independent impact of maternal DM on fetal cardiac function in middle pregnancy. We prospectively recruited mothers with all categories of DM and non-diabetic healthy controls (NDC). Echocardiograms were optimized for chamber quantification and strain analysis. Left atrial area (LAA), LA strain (LAS), right atrial strain (RAS), global longitudinal ventricular strain (GLS) and Right ventricular free wall strain (RV FWS) were evaluated by 2 blinded operators. After excluding 9 mothers with poor fetal image quality, images from 104 mothers with DM and 47 NDC were analyzed. Mothers with DM and NDCs were well matched for age, blood pressure, smoking prevalence, and gestational age. Fetal heart rate (FHR) was significantly higher in fetuses of mothers with DM compared to NDC (147 ± 10bpm vs. 144 ± 8, p = 0.04). LAA in fetuses of mothers with DM trended towards being larger in size (1.68 ± 0.4cm2 vs. 1.56 ± 0.4cm2, p = 0.08). Fetal septal diameters were larger in maternal DM compared to NDC (2.7 ± 0.5cm vs. 2.5 ± 0.5cm, p = 0.001). GLS was similar between the groups. Fetal LAS was lower in maternal DM (28.8 ± 8.8% vs. 33.3 ± 10.4%, p = 0.007) and was independently associated with maternal DM after adjusting for GLS and FHR. Fetal RAS was lower in maternal DM (27.7 ± 10.4% vs. 31.8 ± 10.3%, p = 0.007), however only determinates were estimated fetal weight and RV FWS. Maternal DM independently impairs fetal LA function in mid pregnancy. These early functional changes in the developing heart warrant future studies investigating impact on cardiovascular health.

Associations of retinal microvascular alterations with diabetes mellitus: an OCTA-based cross-sectional study

BackgroundDiabetes, a health crisis afflicting millions worldwide, is increasing rapidly in prevalence. The microvascular complications triggered by diabetes have emerged as the principal cause of renal disease and blindness. The retinal microvascular network may be sensitive to early systemic vascular structural and functional changes. Therefore, this research endeavored to discern the systemic determinants influencing the retinal microvascular network in patients with and without diabetes.MethodsThe Kailuan Eye Study is a cross-sectional study based on the community-based cohort Kailuan Study. Participants underwent optical coherence tomography angiography (OCTA) (Zeiss Cirrus 5000; Carl Zeiss Meditec) and comprehensive systemic examination. Metrics such as perfusion density (PD), vascular density (VD), foveal avascular zone (FAZ) parameters of the superficial capillary plexus (SCP) in the macula were assessed.ResultsThis study included 860 eligible participants (average age = 62.75 ± 6.52 years; 21.9% female), of which 449 were diabetics. People with diabetes had diminished PD and VD in the entire macular and parafoveal regions compared to people without diabetes. Reduced PD in the whole macular region was correlated with higher fasting plasma glucose (FPG, mmol/L) concentration (Beta = -0.19, 95% CI = -0.42 to -0.36, P < 0.001), longer axial length (AL, mm) (Beta = -0.13, 95%CI = -0.48 to -0.25, P = 0.002), and elevated heart rate (Beta = -0.10, 95%CI = -0.14 to -0.19, P = 0.014), after adjusting for younger age (Beta = -0.18, 95%CI = -0.24 to -0.35, P < 0.001), consistent with VD of the whole macular region. A higher FPG level was significantly correlated with lower SCP density of both PD and VD in the macular and parafoveal region (P < 0.05 for all), as well as increased systolic blood pressure and low-density lipoprotein cholesterol concentration (P < 0.01 for all).ConclusionsIn this large-sample cross-sectional study, OCTA evaluation revealed that high prevalence of diabetes and elevated FPG levels were correlated with reduced retinal VD and PD. Hypertension and hyperlipidemia are important risk factors for the development of atherosclerotic cardiovascular disease but have no significant effect on retinal microvascular abnormalities.