Features Of Disease Research Articles

Imaging in Pachychoroid Disease.

The term pachychoroid was proposed as a term indicating an abnormal increase in choroidal thickness. Eyes presenting with pachychoroid changes often exhibit dilation of the large choroidal vessels, compressing the overlying choriocapillaris and Sattler's layer. Pachychoroid spectrum diseases may present pathological findings such as pigment epitheliopathy, choroidal neovascularization (CNV), submacular serous detachment, and distinct choroidal and scleral alterations. Recent advancements in imaging modalities such as widefield indocyanine green angiography (WF-ICGA), optical coherence tomography angiography (OCTA), and enhanced depth imaging optical coherence tomography (OCT) have significantly improved our understanding of these conditions. WF-ICGA revealed venous outflow congestion in the peripheral retina as one of the characteristics of pachychoroid diseases. Scleral thickness measurements using ultrasound biomicroscopy and anterior segment OCT indicate that a thicker anterior sclera may contribute to choroidal congestion and disease pathogenesis. OCTA has emerged as a superior tool for identifying CNV and understanding the disease etiology, offering better sensitivity and specificity compared to traditional methods. These imaging advancements provide valuable insights into the structural and functional changes associated with pachychoroid diseases, potentially guiding future diagnostic and therapeutic strategies. The aim of the present review is to define the morphological characteristics of the pachychoroid spectrum of diseases, which share similar choroidal findings.

Antihypertensive Medication Class and Functional Outcomes After Nonlobar Intracerebral Hemorrhage.

Hypertension is the predominant pathology underlying nonlobar intracerebral hemorrhage (ICH), and antihypertensive agents have distinct biological implications for cerebral microvasculature. It is unknown if the class of antihypertensive medications initiated after ICH affects functional outcome beyond blood pressure (BP) control. To ascertain the association between the class of antihypertensive agents initiated during hospitalization and 90-day functional outcome in nonlobar ICH. This cohort study uses data from the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study, a case-control cohort study investigating ICH risk factors among Hispanic, non-Hispanic Black (hereafter Black), and non-Hispanic White (hereafter White) populations at 42 US hospitals from 2010 to 2015. Data for this analysis were examined from May to September 2024. ERICH study participants were selected for the present analysis if they survived hospitalization and had available covariate and outcome data. Individuals with complications that would limit antihypertensive choice were excluded. Initiation of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), calcium channel blocker, β-blocker, thiazide diuretic, and other antihypertensive medications during index hospitalization. Primary outcome was a favorable functional outcome, defined as a 90-day (follow-up) modified Rankin Score score of 0 to 2 (score range: 0 [indicating no disability] to 6 [indicating death]). Mixed-effects logistic regression adjusted for demographic characteristics, medical history, ICH characteristics, BP measurement, total number of antihypertensive medications, and hospitalization site was used to calculate the odds of favorable functional outcome. Of the 1561 ERICH study participants in the analytic cohort, 1079 had nonlobar and 482 had lobar ICH. Among the 1079 participants in the nonlobar ICH group (mean [SD] age, 58.5 [12.9] years; 676 males [62.6%]; 429 Hispanic [39.8%], 388 Black [36.0%], and 262 White [24.4%] individuals), a total of 407 (37.7%) ACEIs or ARBs, 419 (38.8%) β-blockers, 503 (46.6%) calcium channel blockers, 180 (16.7%) thiazide diuretics, and 277 (25.7%) other antihypertensive classes were initiated during hospitalization (median [IQR], 3 [2-3] agents at discharge). At follow-up, 481 participants (44.6%) had a favorable functional outcome. Initiation of ACEI or ARB was associated with higher odds of favorable functional outcome (adjusted OR [AOR], 1.49; 95% CI, 1.08-2.05; P = .01). No other antihypertensive class was associated with functional outcome. Findings were consistent across several sensitivity analyses. The interaction with ACEI or ARB was mediated by the presence of radiographic features of cerebral small vessel disease (AOR, 3.04; 95% CI, 1.01-9.19; P = .049). No association with class of antihypertensive agent was observed in lobar ICH. This large cohort study found that initiation of ACEI or ARB was associated with favorable 90-day functional outcomes after nonlobar ICH. This finding supports a medication class-specific benefit in hypertensive arteriopathy.

Cigarette smoke components modulate the MR1-MAIT axis.

Tobacco smoking is prevalent across the world and causes numerous diseases. Cigarette smoke (CS) compromises immunity, yet little is known of the components of CS that impact T cell function. MR1 is a ubiquitous molecule that presents bacterial metabolites to MAIT cells, which are highly abundant in the lungs. Using in silico, cellular, and biochemical approaches, we identified components of CS that bind MR1 and impact MR1 cell surface expression. Compounds, including nicotinaldehyde, phenylpropanoid, and benzaldehyde-related scaffolds, bound within the A' pocket of MR1. CS inhibited MAIT cell activation, ex vivo, via TCR-dependent and TCR-independent mechanisms. Chronic CS exposure altered MAIT cell phenotype and function and attenuated MAIT cell responses to influenza A virus infection in vivo. MR1-deficient mice were partially protected from the development of chronic obstructive pulmonary disease (COPD) features that were associated with CS exposure. Thus, CS can impair MAIT cell function by diverse mechanisms, and potentially contribute to infection susceptibility and disease exacerbations.

650 Prevalence and characteristics of chronic kidney disease in patients with inflammatory bowel disease: tertiary single center experience

650 Prevalence and characteristics of chronic kidney disease in patients with inflammatory bowel disease: tertiary single center experience

CT Honeycombing and Traction Bronchiectasis Extent Independently Predict Survival across Fibrotic Interstitial Lung Disease Subtypes.

Background Prognostic value of radiologic features in interstitial lung disease (ILD) has been predominantly studied in idiopathic pulmonary fibrosis, but findings vary. The relative importance of features versus guideline-defined patterns in predicting outcomes is unknown. Purpose To identify radiologic features that are independently associated with transplant-free survival beyond clinical predictive factors across all ILD subtypes, and to identify whether individual features versus patterns are more important for prognostication. Materials and Methods This is a secondary analysis of the prospective Canadian Registry for Pulmonary Fibrosis. Consecutive patients with ILD were evaluated in standardized multidisciplinary discussions between January 2021 and March 2022. Radiologic features on thin-section CT images were quantified, and guideline-defined usual interstitial pneumonia (UIP) and fibrotic hypersensitivity pneumonitis (fHP) patterns were assigned. Multivariable Cox analysis was used to assess the associations of radiologic features with transplant-free survival, and nested models were used to test the relative importance of features compared with patterns. Results A total of 1593 patients (mean age, 66 years ± 12 [SD]; 800 male) were included. The following four features were associated with transplant-free survival: extent of honeycombing (hazard ratio, 1.20; 95% CI; 1.06, 1.36 per 10% increase in lung involvement; P = .005), extent of traction bronchiectasis (hazard ratio, 1.18; 95% CI: 1.10, 1.26 per 10% increase; P < .001), pulmonary artery diameter (hazard ratio, 1.03; 95% CI: 1.01; 1.04 per 1-mm increase; P = .002), and presence of subpleural sparing (hazard ratio, 0.76; 95% CI: 0.56, 0.96; P = .03). Guideline-defined patterns were not independently associated with survival in a model that included these four radiologic features, each of which retained its prognostic value. Conclusion The extent of fibrosis was predictive of worse outcomes across all ILD subtypes in a dose-dependent fashion and independent of well-recognized clinical prognostic factors. Guideline-defined UIP and fHP patterns each helped risk-stratify patients in isolation but lost prognostic value when accounting for the extent of fibrosis, suggesting that their previous association with mortality is based on these patterns acting as surrogates for a greater extent of fibrosis. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Wells in this issue.

Cholinergic Denervation Patterns in Parkinson's Disease Associated With Cognitive Impairment Across Domains.

Cognitive impairment is considered to be one of the key features of Parkinson's disease (PD), ultimately resulting in PD-related dementia in approximately 80% of patients over the course of the disease. Several distinct cognitive syndromes of PD have been suggested, driven by different neurotransmitter deficiencies and thus requiring different treatment regimes. In this study, we aimed to identify characteristic brain covariance patterns that reveal how cholinergic denervation is related to PD and to cognitive impairment, focusing on four domains, including attention, executive functioning, memory, and visuospatial cognition. We applied scaled sub-profile model principal component analysis to reveal cholinergic-specific disease-related and cognition-related covariance patterns using [18F]fluoroethoxybenzovesamicol PET imaging. Stepwise logistic regression was applied to predict disease state (PD vs. healthy control). Linear regression models were applied to predict cognitive functioning within the PD group, for each cognitive domain separately. We assessed the performance of the identified patterns with leave-one-out cross validation and performed bootstrapping to assess pattern stability. We included 34 PD patients with various levels of cognitive dysfunction and 10 healthy controls, with similar age, sex, and educational level. The disease-related cholinergic pattern was strongly discriminative (AUC 0.91), and was most prominent in posterior brain regions, with lower tracer uptake in patients compared to controls. We found largely overlapping cholinergic-specific patterns across cognitive domains, with positive correlations between tracer uptake in the opercular cortex, left dorsolateral prefrontal cortex and posterior cingulate gyrus, among other regions, and attention, executive, and visuospatial functioning. Cross validation showed significant correlations between predicted and measured cognition scores, with the exception of memory. We identified a robust structural covariance pattern for the assessment of cholinergic dysfunction related to PD, as well as overlapping cholinergic patterns related to attentional, executive- and visuospatial impairment in PD patients.

Dysfunctional KLRB1+CD8+ T-cell responses are generated in chronically inflamed systemic sclerosis skin.

To analyse the immune mechanisms of diffuse cutaneous systemic sclerosis (dcSSc) skin disease focusing on CD8+ T-cell responses in the affected skin of patients because chronic inflammation, vasculopathy, and extensive cutaneous fibrosis are prominent features of dcSSc skin disease, causing pain and disability in patients, with no effective therapy. Single-cell transcriptomics and epigenomics were applied to well-characterised patient skin samples to identify transcriptomes and key regulators of skin-resident CD8+ T-cell subsets. Multicolor immunofluorescence miscoscopy was used to validate molecular findings. Ex vivo skin explant assays were used to functionally characterise dysfunctional CD8+ T-cell subsets on nonlesional autologous skin. We identified 2 major developmentally connected CD8+ T-cell subpopulations that were expanded in SSc skin lesions compared with healthy control skin. The first was a heterogeneous subset of effector-memory CD8+KLRB1+IL7R+ cells characterised by increased cytolytic and Tc2/Tc17 effector functions that appear to induce tissue damage and fibrosis in early-stage dcSSc skin lesions. The second, found primarily in patients with late-stage disease, was an exhausted CD8+KLRG1+IL7R- subset that exhibited transcriptional features of long-lived effector cells, likely contributing to chronic inflammation. Significantly, both subsets were also expanded in other benign dermatoses, implicating these cell populations in the pathogenesis of chronic human skin inflammation. This study provides new insight into core regulatory programmes modulating skin-resident CD8+ T-cell plasticity and identifies distinct CD8+ T-cell subpopulations that contribute to initiation and chronicity of inflammatory responses in systemic sclerosis skin lesions. These findings reveal prospective molecular targets for new therapeutic strategies against this incurable disease.

Phenotypic and genotypic features of von Willebrand disease in Hong Kong

Phenotypic and genotypic features of von Willebrand disease in Hong Kong

Clinical and neuropathological associations of plasma Aβ42/Aβ40, p-tau217 and neurofilament light in sporadic frontotemporal dementia spectrum disorders.

Plasma amyloid beta42/amyloid beta40 (Aβ42/Aβ40) and phosphorylated tau217 (p-tau217) identify individuals with primary Alzheimer's disease (AD). They may detect AD co-pathology in the setting of other primary neurodegenerative diseases, but this has not been systematically studied. We compared the clinical, neuroimaging, and neuropathological associations of plasma Aβ42/Aβ40 (mass spectrometry), p-tau217 (electrochemiluminescence), and neurofilament light ([NfL], single molecule array [Simoa]), as markers of AD co-pathology, in a sporadic frontotemporal dementia (FTD) cohort (n=620). Aβ42/Aβ40 showed no clinicopathological associations. High p-tau217 was present in amnestic dementia (AmD) presumed to be due to FTD, logopenic primary progressive aphasia (lvPPA), and APOEε4 carriers, and correlated with worse baseline and longitudinal clinical scores, lower hippocampal volumes, and more severe AD co-pathology (Braak Stage). NfL was elevated in all FTD phenotypes, and correlated with clinical scores and frontotemporal brain volumes. Plasma p-tau217 has clinical, neuroimaging, and neuropathological correlates in sporadic FTD and may identify FTD cases with AD co-pathology. Alzheimer's disease (AD) features could be identified with plasma phosphorylated tau217 (p-tau217) in frontotemporal lobar degeneration (FTLD).Plasma p-tau217 is a better discriminator of AD co-pathology and AD-associated features in FTLD than plasma amyloid beta42/amyloid beta40 (Aβ42/Aβ40) and neurofilament light (NfL).In FTLD, plasma p-tau217, but not Aβ42/Aβ40 or neurofilament light, has phenotypical, neurocognitive, and neuroimaging correlates suggestive of AD co-pathology.

Comparative characteristics of diseases of the bone and joint system of horses in typical equestrian sports (show jumping, dressage, endurance)

As a rule, much attention is paid to injuries of the tendon-ligament apparatus of horses used in various types of equestrian sports. And often diagnostics of injuries of the musculoskeletal system is carried out. However, absolutely undeservedly, in the diagnosis of injuries of the musculoskeletal system little attention is paid to ultrasound. As a rule, to obtain the most complete information about the state of the musculoskeletal system, it is necessary to combine these 2 research methods. Ultrasound makes sense to carry out both in the diagnosis of diseases of the tendon-ligament apparatus and in the diagnosis of joint diseases, because it is important to remember that the joint consists not only of articular surfaces, but also of a capsule with synovial membranes, joint cavity, joint ligaments - all these structures require a comprehensive assessment. Earlier, we found that horses training in equestrian distance endurance on hilly terrain have predominantly periosteal reactions at the attachment points of the joint ligaments. We then decided to conduct a study of musculoskeletal injuries in comparison in different types of equestrian sports. In our opinion, endurance riding is of the greatest interest, since this type of equestrian sport in the North-West region is younger than show jumping and dressage. As a result of the studies, it was concluded that diseases of the musculoskeletal system differ in different disciplines, and there are also similarities.

Comparison of risk factors, treatment strategy, and outcomes of early- vs. older-onset colorectal cancer within the prospective ColoCare study.

95 Background: The incidence of colorectal cancer among young adults aged 20-49 has continually increased in recent decades. Early-onset colorectal cancer (EOCRC) patients are more likely to be diagnosed at a more advanced stage of disease, have hereditary cancer syndromes, and have different molecular pathological features of disease than later-onset patients. Herein we compare the risk factors, treatment approaches, and responses to treatment of early-onset versus later-onset colorectal cancer within. Methods: The ColoCare Study is a prospective cohort enrolling individuals diagnosed with primary colorectal cancer at six different cancer centers in the United States and one in Germany. Serial questionnaires assess demographic characteristics and symptoms experienced prior to diagnosis, while clinical characteristics (including staging, pathology, treatments given) are abstracted from medical records. Restricting to patients with available age and stage, patients diagnosed &lt;50 years old were labeled as “early-onset” and ≥50yo as “later-onset.” Associations between patient age and characteristics of interest were tested using Fisher’s Exact Test for count data. Results: Of the3,173 patients included in this analysis, 78% were later-onset (mean: 65 years) and 22% were early-onset (mean: 42 years). Demographic data was comparable between the two groups, with 43% being female. Though similar rates of ever alcohol use were seen between the two groups, early-onset patients reported consuming fewer weekly alcoholic beverages than later-onset patients (mean (standard deviation) of 5.5 (6.6) vs. 8.4 (9.3)). Early-onset patients were less likely to have ever smoked tobacco (38% vs 51%, p&lt;0.001) and had lower rates of obesity (27% vs 31%) or overweight (34% vs 40%) than later-onset patients (p&lt;0.001). For stage II/III disease, early-onset patients were more likely to have received chemotherapy and/or radiation treatment compared to later-onset patients (87% vs 70%, p&lt;0.001), though both groups had similar rates of surgery. Despite this, younger patients did not appear to experience better outcomes, with 21% of younger patients experiencing a recurrence or new metastasis during follow-up versus 20% of later-onset patients. Conclusions: The risingincidence of colorectal cancer in early-onset patients does not appear to be explained by traditional risk factors such as alcohol use, tobacco use, or high BMI. Early-onset patients are more likely to receive chemotherapy or radiation, but observed outcomes are notably poorer compared to later-onset patients. Further statistical analysis on specifics of treatments by stage is ongoing.

Association study of the HLA class I system with psoriatic arthritis in Southern Tunisia: a case-control study.

Psoriatic arthritis (PsA) is a chronic inflammatory rheumatism belonging to the spondyloarthritis family. It is a multifactorial disease whose genetic determinism is still poorly understood. It is favored by environmental factors in genetically predisposed individuals. This study aims to investigate the association of HLA-A, HLA-B, and HLA-C alleles with PsA and its various manifestations in patients from Southern Tunisia. A case-control association study was conducted involving 48 PsA patients and 123 controls. HLA-A and HLA-B typing was performed using microlymphocytotoxicity complement-dependent assays, and HLA-C typing was done using polymerase chain reaction-sequence specific primer. Positive associations were confirmed for HLA-B27 and -C*06 alleles with PsA in our Southern Tunisian population with a more pronounced association in cases of -C*06 homozygosity. The HLA-B*27-C*02 and HLA-B*50-C*06 haplotypes were significantly more frequent in PsA patients, whereas the HLA-B*35-C*04 haplotype was negatively associated with PsA. Specific HLA alleles were linked to disease manifestations: -C04 with female sex, -B27 with familial spondyloarthritis, and -B17 with sporadic PsA. Cervical spine involvement was associated with -C02, and hip involvement with -B35 and -C02. Uveitis was linked to -C02 and -B27. A negative association was observed between a BASFI score > 4 and the presence of -B45 and -C07. The HLA class I system contributes to PsA susceptibility in the Southern Tunisian population. Key Points • This is the first study exploring the association between HLA class I alleles and psoriatic arthritis in Southern Tunisia. • HLA-B27 and -C06 alleles are strongly associated with PsA, with a more pronounced effect in -C06 homozygosity. • Specific HLA alleles are linked to clinical manifestations: -B27 is associated with familial PsA, -B17 with sporadic PsA, and -B35 with hip involvement. • These findings provide insights into the genetic contribution to PsA pathophysiology in Southern Tunisia and highlight the role of HLA alleles in specific disease features.

Advances in the Pathogenesis, Diagnosis, Treatment, and Prognosis of Marginal Zone Lymphoma.

The management of marginal zone lymphoma (MZL), an indolent B-cell non-Hodgkin lymphoma, requires a personalized and adaptive approach due to its clinical and prognostic heterogeneity. We believe treatment should emphasize a balanced strategy considering the subtype, disease burden, symptoms, and actionable genetic or environmental factors, such as infections or autoimmune diseases. For asymptomatic patients with low tumor burden or disseminated disease, a watch-and-wait approach remains appropriate, given MZL's indolent nature and the risks of overtreatment. Conversely, for symptomatic or high-burden cases, early intervention with chemoimmunotherapy is recommended for effective disease control. Surgery remains essential for both diagnosis and the treatment of localized disease. Incorporating molecular profiling and prognostic models, such as MZL-IPI and POD24, is crucial for decision-making and risk stratification. Testing for infectious agents like Helicobacter pylori or Hepatitis C virus should be standard practice, as eradication therapy offers a targeted, less toxic, and effective option in select patients. With ongoing advancements in understanding dysregulated signaling pathways and the tumor microenvironment, we anticipate novel targeted therapies and combination regimens will further improve outcomes. We advocate for molecular testing at diagnosis to identify actionable biomarkers, particularly for patients with refractory or relapsed disease. Finally, MZL management requires vigilant follow-up with adjustments based on evolving disease features. Treatment decisions should integrate patient preferences, clinical context, and the latest evidence to maximize survival while preserving quality of life.

Clinical and sociodemographic characteristics of alzheimer's disease and related dementias (AD/ADRD) among people living with HIV: a cross-sectional analysis.

Alzheimer's disease and related dementias (AD/ADRD) continue to be a public health challenge. People living with HIV (PLWH) are at risk for neurocognitive disorders and may be at risk for AD/ADRD. However, studies examining clinical and sociodemographic factors associated with AD/ADRD among PLWH are lacking. Therefore, the aim of this cross-sectional study was to determine the association between selected sociodemographic (age, gender, race and rurality) and clinical (depression and encephalopathy) factors with (AD/ADRD) among PLWH. Data were obtained from the South Carolina Revenue and Fiscal Affairs (RFA) Office and the South Carolina Alzheimer's Disease Registry (N = 13,390). Multivariable logistic regression models were used to determine the association between age, gender, race, rurality, depression and encephalopathy, and AD/ADRD among PLWH. Among the study population (N = 13,390), 5% (n = 601) were found to have AD/ADRD. There was a dose-response relationship between age group and AD/ADRD whereas the age group increased, the association increased. For example, those who were aged 80 years and older were 80 times more likely to have AD/ADRD compared to those aged 18-29 years (aOR: 80.4; 95% CI: 40.2-160.8). Additionally, male sex (aOR: 1.3; 95% CI: 1.9-1.6) and encephalopathy (aOR: 2.4; 95% CI: 1.9-3.2) were positively associated with AD/ADRD for PLWH. AD/ADRD interventions may be warranted among PLWH, especially among older adults, men, and those with encephalopathy. Future studies should examine potential pathways between clinical and sociodemographic characteristics and AD/ADRD among PLWH.

High glucose/ChREBP-induced Hif-1α transcriptional activation in CD4+ T cells reduces the risk of diabetic kidney disease by inhibiting the Th1 response.

Diabetic kidney disease (DKD) features intrarenal inflammation, in which T cells play a part. Hypoxia-inducible factor-1α (HIF-1α), a key transcription factor regulating cellular responses to hypoxia, is reportedly involved in the course of inflammation. The role of HIF-1α in DKD has been investigated, but the conclusions are controversial so far. We report a previously unrecognised high glucose/carbohydrate response element binding protein (ChREBP)/Hif-1α transcription axis in CD4+ T cells. Lck-Cre+Hif1aloxp/loxp (Hif-1α-/-) mice were generated to explore the role of T cell HIF-1α in the pathogenesis of DKD. CD4+ T cells sorted from T cell-specific Hif-1α-ablated mice and wild-type mice were used for functional studies and transcriptional profiling. In this study, we used Lck-Cre transgenic mice to specifically disrupt Hif-1α in T cells and found that ablation of Hif-1α greatly accelerated the progression of DKD in a streptozocin-induced model of diabetes. Adoptive transfer of splenic CD4+ T cells from Hif-1α-/- mice rather than wild-type controls to diabetic mice elicited severe renal damage. Compared with wild-type controls, Hif-1α knockout markedly promoted IFN-γ secretion by CD4+ T cells in response to high glucose. Additional Ifn-γ ablation negated the effect of Hif-1α knockout on DKD progression. Mechanistically, the background Hif-1α mRNA synthesis rate in resting T cells was very low, but culture of T cells under high glucose led to significantly promoted Hif-1α expression, which was dependent on the transcription factor ChREBP. Consistent with results from Hif-1α-/- CD4+ T cells, adoptive transfer of Chrebp-/- CD4+ T cells to wild-type diabetic mice also elicited severe diabetic renal damage. By contrast, Chrebp-/-Ifn-γ-/- CD4+ T cells failed to show nephrotoxic effects. Examination of the Hif-1α promoter identified a ChREBP-binding sequence that mediated transcriptional upregulation of Hif-1α by high glucose. Our study reveals a previously unrecognised high glucose/ChREBP/Hif-1α transcription axis in CD4+ T cells, which serves as a self-protection mechanism against DKD progression via limiting T helper 1 response.

P-898. Reproducible profiling of eight Brazilian infectious diseases specialist training sites through open databases

Abstract Background Many factors influence the choice of a specialty and a residency training site after essential medical education, including hospital characteristics. We set out to explore characteristics of infectious diseases (ID) and pediatric ID training sites in one Brazilian state, aiming to provide a data-driven input into residency site choice. Number of hospitalizations and age and sex of patients (A) Absolute number of hospitalizations per institution in the 10-year period, and (B) proportion of hospitalizations in each institution along the years. (C) Violin plots of ages for each institution with the same maximum width, and inner boxplots with width proportional to hospitalization count. (D) Frequency plots of male and female patients hospitalized in each institution, with (E) corresponding area plots adding to 100% for every age. Methods We performed a retrospective, descriptive study of hospitalizations in institutions which offer ID and/or peds ID medical training, using Ministry of Health openly available hospitalization databases as sources. We used R software version 4.3.1 for analysis to ensure reproducibility. Procedures performed, length of hospital stay and intensive care unit costs per institution (A) Proportion of diagnostic, clinical, surgical and transplant procedures carried out in each hospital. (B) Proportion of specialty associated with hospital bed used for each hospitalization. (C) Violin plots of days of hospital stay for each institution. (D) Violin plots of total ICU costs (US dollars, log scale) in each hospitalization for each hospital; (E) the same plot, after removing COVID hospitalizations. Results Eight institutions from Rio de Janeiro (RJ) fit the criteria and had available data. From January 2013 to December 2022, they carried out 583,362 hospitalizations. Two hospitals (HGNI, HUPE) accounted for 56.6% of these. The hospitals with peds ID positions (IPPMG, IFF) have different age distributions because one also admits birthing mothers. Most admissions were due to clinical or surgical procedures, with a minority cataloged as diagnostic procedures or cell, tissue and organ transplants. Most patients were discharged within 7 days. HUCFF had the highest proportion of diagnostic and transplant procedures (1.88% and 2.12%, respectively). On average, university hospitals are paid 2∼3 times as much as other institutions per hospitalization. Overall disease burden was diverse, but INI stood out as a center for HIV care. Proportions of ICD-10 chapters or subchapters as leading causes of hospitalization Heatmaps with unsupervised clustering of ICD-10 chapter or subchapter frequency as leading cause of hospitalization, for all hospitalizations (A), for hospitalizations filed under “clinical treatment of infectious and parasitic diseases” or “clinical treatment of HIV/AIDS” (B), or for hospitalizations filed under ICD-10 chapters I or VI (C). Conclusion Hospitals in RJ with ID and peds ID residency spots have distinct workloads, patient profiles, disease burden and government-paid income. Residents from these programs might express similar views, but they do not necessarily reflect the widest picture, and might not be accessible to all interested candidates. Although subjectivity should not be discarded when choosing a training site, open data can inform more precise, transparent distinctions. For example, candidates interested in transplant ID could be more inclined to choose HUCFF, while candidates interested in less complex care could opt for HGNI. The framework we provide can also be employed to analyze other programs and hospitals, such as surgical residencies. Not all hospitals with residency positions feed these databases, thus limiting our analysis. Disclosures All Authors: No reported disclosures

P-757. Microbiological and clinical characteristics of extrapulmonary nontuberculous mycobacterial disease in a Chinese general hospital

Abstract Background Data on extrapulmonary nontuberculous mycobacterial disease (ENTM) in China is lacking. We aim to explore the microbiological and clinical characteristics of ENTM in a general hospital. Methods Laboratory extrapulmonary samples positive for nontuberculous mycobacteria in Zhongshan Hospital, Fudan University between Jan. 2017 and Dec. 2021 were retrospectively searched. The respective patient data were reviewed and followed until Dec. 2022. Thirty-three confirmed ENTM cases were included. Demographic, microbiological, clinical characteristics, as well as treatment and prognosis were analyzed. Results A total of 33 confirmed ENTM cases were included. The average age was (49±16.3) years. Twenty-three cases (69.7%) were female and one third of the patients were immunocompromised. Skin and soft tissue infection, bone and joint infection, and disseminated NTM disease were the most common types (57.6%, 18.2%, and 15.6%). Healthcare-associated infections accounted for 51.5% (17/33) of the cases. Mycobacterium abscessus complex (42.4%) among rapidly growing mycobacteria (RGM) was the most common causative species. Patients received combination therapy with an average of (3.5±0.8) drugs for 6.3 (4.3,9.6) months. Most cases recovered (69.7%) or improved clinically (18.2%). Compared with RGM, infections with slowly growing mycobacteria (SGM) were seen in older individuals (60.2±15.0 vs 42.6±14.0, P&amp;lt;0.05) and were more often community-acquired (83.3% vs 28.6%, P&amp;lt;0.05). Conclusion Skin and soft tissue infection is the most common type of ENTM, with Mycobacterium abscessus complex being the most important causative species. SGM infections affect older population and are more often community-acquired. Treatment of ENTM is challenging and lacks standardized protocol, future researches are warranted. Disclosures All Authors: No reported disclosures

Self-critical strategy adjustment based artificial intelligence method in generating diagnostic reports of respiratory diseases

Objective. Humanity faces many health challenges, among which respiratory diseases are one of the leading causes of human death. Existing AI-driven pre-diagnosis approaches can enhance the efficiency of diagnosis but still face challenges. For example, single-modal data suffer from information redundancy or loss, difficulty in learning relationships between features, and revealing the obscure characteristics of complex diseases. Therefore, it is critical to explore a method that can assist clinicians in detecting lesions early and in pre-diagnosing corresponding diseases.Approach.This paper introduces a novel network structure, strong constraint self-critical strategy network (SCSCS-Net), which can effectively extract image features from chest x-ray images and generate medical image descriptions, assist clinicians in analyzing patients' medical imaging information, deeply explore potential disease characteristics, and assist in making pre-diagnostic decisions. The SCSCS-Net consists of a reinforced cross-modal feature representation model and a self-critical cross-modal alignment model, which are responsible for learning the features interdependence between images and reports by using a multi-subspace self-attention structure and guiding the model in learning report generation strategies to improve the professionalism and consistency of medical terms in generated reports, respectively.Main results.We further compare our model with some advanced models on the same dataset, and the results demonstrate that our method achieves better performance. Finally, the CE and NLG metrics further confirm that the proposed method acquires the ability to generate high-quality medical reports with higher clinical consistency in generating medical reports.Significance.Our novel method has the potential to improve the early detection and pre-diagnosis of respiratory diseases. The model proposed in this paper allows to narrow the gap between artificial intelligence technology and clinical medical diagnosis and provides the possibility for in-depth integration.

P-1994. Rapid COVID-19 Transmission and Multi-layered Interventions in a High-rise Detention Center from January to March 2022 in South Korea

Abstract Background Correctional and detention facilities face significant challenges in controlling the spread of highly infectious pathogens such as SARS-CoV-2 due to overcrowded conditions, inadequate ventilation, and shared facilities. Despite reports on COVID-19 outbreaks in various correctional settings worldwide, investigations into outbreaks in metropolitan high-rise prisons remain scarce, warranting detailed examination. Diagnosed cases of coronavirus diseases 2019 (COVID-19) in detention center (blue) and South Korea (yellow), January through March 2022 Methods The detention center, which covers an area of 41,658 mm2, can accommodate 2,070 individuals and housed 1,977 inmates and 674 correctional officers at the time of outbreak detection. The facility comprises five buildings, including one 10-story and four 12-story buildings, with 47 wards. Each building is connected with the following building through a common hallway located at the distal end of each building. Descriptive analyses were conducted on demographic characteristics, symptom onset dates, comorbidities, vaccination status, and exposure history of confirmed COVID-19 cases. Vaccine effectiveness was estimated using logistic regression models. Epidemic curve of SARS-CoV-2 case-patients by building and floor(vertical axis), South Korea, 2022 Results From January 25 to March 2, 2022, 492 people, including 474 (30.0%) of 1,977 incarcerated persons (cumulative attack rate of 24%) and 18 (2.7%) of 674 staff members at the detention center, were confirmed with SARS-CoV-2 infection. High-rise facility characteristics contributed to rapid transmission, with the index case identified on January 25, 2022. However, the implementation of physical distancing, decarceration, limiting movement, and conducting serial and mass testing, despite being complex and requiring substantial resources, effectively slowed the spread of the Omicron variant amidst persistent community transmission. Vaccine effectiveness against infection was estimated at 52.7% (95% confidence interval, 37.2% to 64.4%) for three doses. Characteristics of coronavirus disease 2019 case-patients in a detention center, South Korea, 2022 Conclusion The findings underscore the vulnerability of high-rise detention centers to COVID-19 outbreaks and emphasize the effectiveness of multi-layered interventions in curbing transmission. Swift and comprehensive measures are crucial for controlling outbreaks in high-density, enclosed settings, informing future pandemic response efforts and policy development. Disclosures All Authors: No reported disclosures

Aging disrupts the coordination between mRNA and protein expression in mouse and human midbrain.

Age-related dopamine (DA) neuron loss is a primary feature of Parkinson's disease. However, whether similar biological processes occur during healthy aging, but to a lesser degree, remains unclear. We therefore determined whether midbrain DA neurons degenerate during aging in mice and humans. In mice, we identified no difference in midbrain neuron numbers throughout aging. Despite this, we found age-related decreases in midbrain mRNA expression of tyrosine hydroxylase (Th), the rate limiting enzyme of DA synthesis. Among midbrain glutamatergic cells, we similarly identified age-related declines in vesicular glutamate transporter 2 (Vglut2) mRNA expression. In co-transmitting Th+/Vglut2+ neurons, Th and Vglut2 transcripts decreased with aging. However, Th and Vglut2 protein levels in striatal synaptic release sites (e.g., terminals and axonal projections) did not differ throughout aging. Similar to the mouse, an initial study of human brain showed no effect of aging on midbrain neuron number with a concomitant decrease in TH and VGLUT2 mRNA expression. Unlike in mice, the density of striatal TH+ dopaminergic terminals was lower in aged human subjects. However, TH and VGLUT2 protein levels were unaffected in the remaining striatal boutons. Finally, in contrast to Th and Vglut2 mRNA, expression of most ribosomal genes in Th+ neurons was either maintained or even upregulated during aging. This suggests a homeostatic mechanism where age-related declines in transcriptional efficiency are overcome by ongoing ribosomal translation. Overall, we demonstrate species-conserved transcriptional effects of aging in midbrain dopaminergic and glutamatergic neurons that are not accompanied by marked cell death or lower striatal protein expression. This opens the door to novel therapeutic approaches to maintain neurotransmission and bolster neuronal resilience.