Functional Changes In Patients Research Articles

Association Between Trough Level of Tacrolimus and Change in Estimated Glomerular Filtration Rate 1 Year After Living Donor Liver Transplantation.

BackgroundAlthough the risk factors for chronic kidney disease progression after deceased donor liver transplantation have been widely reported, there are few reports describing the factors associated with kidney function changes in patients after living donor liver transplantation (LDLT). This study aims to further investigate these kidney function change factors.Material/MethodsThis retrospective study was performed using the data of patients who underwent LDLT at the Nagasaki University Hospital, Japan from August 2000 to November 2017. Factors contributing to post-transplantation estimated glomerular filtration rate (eGFR) changes were analyzed.ResultsA total of 191 cases were reviewed. The average age was 53.8 years, and 108 (56.5%) patients were male. Compared to pre-transplantation eGFR levels, eGFR 1 year after LDLT improved in 65 patients (34%) and deteriorated in 126 patients (66%). Multivariate regression analysis revealed that pre-transplant diuretics (P=0.04) and tacrolimus trough value 1 year after transplantation (P=0.04) were significantly associated with elevated eGFR changes. eGFR elevation 1 year after LDLT was more pronounced in patients with a low tacrolimus trough level 1 year after LDLT (P=0.01). Therefore, mycophenolate mofetil was added to tacrolimus in patients with poor renal function before LDLT.ConclusionsTacrolimus trough level was associated with eGFR changes 1 year after LDLT. The adjusted dose of tacrolimus and combined use of other immunosuppressants may be important to maintain renal function after LDLT.

Preoperative evaluation for lung resection in patients with bronchiectasis: should we rely on standard lung function evaluation?

The scant data about non-cystic fibrosis bronchiectasis, including tuberculosis sequelae and impairment of lung function, can bias the preoperative physiological assessment. Our goal was to evaluate the changes in lung function and exercise capacity following pulmonary resection in these patients; we also looked for outcome predictors. We performed a non-randomized prospective study evaluating lung function changes in patients with non-cystic fibrosis bronchiectasis treated with pulmonary resection. Patients performed lung function tests and cardiopulmonary exercise tests preoperatively and 3 and 9 months after the operation. Demographic data, comorbidities, surgical data and complications were collected. Forty-four patients were evaluated for lung function. After resection, the patients had slightly lower values for spirometry: forced expiratory volume in 1 s preoperatively: 2.21 l ± 0.8; at 3 months: 1.9 l ± 0.8 and at 9 months: 2.0 l ± 0.8, but the relationship between the forced expiratory volume in 1 s and the forced vital capacity remained. The gas diffusion measured by diffusing capacity for carbon monoxide did not change: preoperative value: 23.2 ml/min/mmHg ± 7.4; at 3 months: 21.5 ml/min/mmHg ± 5.6; and at 9 months: 21.7 ml/min/mmHg ± 8.2. The performance of general exercise did not change; peak oxygen consumption preoperatively was 20.9 ml/kg/min ± 7.4; at 3 months: 19.3 ml/kg/min ± 6.4; and at 9 months: 20.2 ml/kg/min ± 8.0. Forty-six patients were included for analysis of complications. We had 13 complications with 2 deaths. To test the capacity of the predicted postoperative (PPO) values to forecast complications, we performed several multivariate and univariate analyses; none of them was a significant predictor of complications. When we analysed other variables, only bronchoalveolar lavage with positive culture was significant for postoperative complications (P = 0.0023). Patients who had a pneumonectomy had a longer stay in the intensive care unit (P = 0.0348). The calculated PPO forced expiratory volume in 1 s had an excellent correlation with the measurements at 3 and 9 months; but the calculated PPO capacity for carbon monoxide and the PPO peak oxygen consumption slightly underestimated the 3- and 9-month values. However, none of them was a predictor for complications. Better tools to predict postoperative complications for patients with bronchiectasis who are candidates for lung resection are needed. Clinicaltrials.gov: NCT01268475.

Aging and Financial Capacity: Cognitive Correlates of an Early Indicator of Functional Decline

Financial capacity describes the ability to make and carry out sound financial decisions sufficient to meet an individual’s needs for health and well-being. Impairments in financial capacity have been shown to be one of the earliest functional changes in patients with mild cognitive impairment (MCI), the precursor to Alzheimer’s disease and related dementias. Recent developments using online automated monitoring of financial transactions promise a new way to identify the earliest signs of cognitive decline. We examine the feasibility of using secure online technology to link ongoing financial activity monitoring data with other objective measures of function and cognition in a cohort of independent living older adults. To date, 73 older adults (mean age = 76.8, MoCA = 25.9) have enrolled and are participating in a 12-month online financial monitoring program that tracks account activity and generates alerts for unusual or irregular transactions. At baseline participants are administered a battery of neuropsychological tests and the Financial Capacity Instrument (FCI), a measure of financial capacity using tasks of everyday financial activity. Financial monitoring data are collected continuously, and are summarized and reported monthly. Younger participants had more online transactions and higher FCI scores. FCI total score was positively correlated with animal fluency (p < .02), Trails A (p < .03) and B (p < .0001), and visual memory (p < .0008). Number of online transactions in one month was correlated with FCI score, and Trails B (faster time to completion). Lower MoCA scores were associated with higher number of alerts per month.

Short-Term Results of Ocriplasmin Versus Prompt Vitrectomy for Macular Hole. Which Performs Better?

In this retrospective study, we compared the anatomical and functional changes in patients with vitreomacular traction associated with macular holes between the following groups: (1) Patients who were treated with a single intravitreal injection of ocriplasmin (the OCRIALONE group); (2) those who failed the ocriplasmin treatment and underwent vitrectomy one month later (the OCRIVIT group); and (3) patients who directly underwent par plana vitrectomy (VITREALONE group). A total of 38 patients, 19 in the OCRIALONE group + OCRIVIT group (seven and 12 patients, respectively) and 19 in the VITREALONE group with focal vitreomacular adhesion associated with macular holes were evaluated with spectral domain optical coherence tomography. Functional examinations included best-corrected visual acuity (BCVA) and microperimetry analysis. Visual function changes were compared between the OCRIALONE group + OCRIVIT group and VITREALONE group up to three months. Furthermore, a subgroup analysis compared the OCRIVIT group and the VITREALONE group. BCVA values and the mean retinal sensitivity showed statistically significant improvement in all groups (p < 0.001). Specifically, the retinal sensitivity values at the end of the follow-up were significantly higher in the OCRIALONE group + OCRIVIT group than in the VITREALONE group. These functional findings were also confirmed when the statistical analysis was conducted between the OCRIVIT group and the VITREALONE group. Although the OCRIALONE group + OCRIVIT group exhibited faster retinal thinning than the VITREALONE group (p = 0.006), the analysis of the OCRIVIT group versus the VITREALONE group did not show any statistically significant difference. The better functional results and similar anatomical findings suggest that ocriplasmin can be used as a first-line treatment, and that prompt pars plana vitrectomy as primary surgery does not provide better outcomes in comparison with pars plana vitrectomy after ocriplasmin injection.

The 5-question Geriatric Locomotive Function Scale predicts postoperative fall risk in patients undergoing surgery for degenerative cervical myelopathy

BackgroundFalling is one of the main reasons for which older adults require nursing care. Locomotive syndrome (LS) predicts the need for nursing care; however, the relationship between falling and LS remains unclarified. This study aimed to determine whether the 5-question Geriatric Locomotive Function Scale (GLFS-5) predicts postoperative fall risk in patients with degenerative cervical myelopathy (DCM). MethodsThis study is a post hoc analysis of the data from a prospective cohort of patients undergoing surgery for DCM. Participants recorded their falls in a fall diary from the time of study enrollment (baseline) to 1 year postoperatively. Functional assessments were conducted at baseline, hospital admission for surgery, and 1 year postoperatively. Outcome measures included the GLFS-5, Japanese Orthopaedic Association score, Neck Disability Index, EuroQol 5 Dimensions, and 12-Item Short Form Health Survey. Risk factors for falls were investigated, including previous falls, number of medications, and grip strength. Fallers were divided into two categories: all fallers (≥1 falls), and recurrent fallers (≥2 falls). Variables that were significant in univariate analyses were applied in multiple logistic regression models to adjust for confounders. ResultsFrom the initial group of 168 participants, 159 attended the 1-year follow-up, and 132 fall diaries were retrieved and analyzed. Of these 132 patients, 42 (32%) reported at least one fall, while 25 (19%) reported recurrent falls during the postoperative observation period. The GLFS-5 significantly increased from baseline to admission, and significantly decreased from admission to 1 year postoperatively. In multiple logistic regression analysis, the independent predictors of postoperative recurrent falls were previous falls and a higher baseline GLFS-5. The optimal cut-off value of GLFS-5 for predicting all falls/recurrent falls was 12. ConclusionsThe GLFS-5 reflected time-dependent functional changes in patients undergoing surgery for DCM. Previous falls and a higher baseline GLFS-5 were independent predictors of postoperative recurrent falls.

Homocysteine level is positively and independently associated with serum creatinine and urea nitrogen levels in old male patients with hypertension

A cross-sectional study to show whether and how serum fasting homocysteine levels are associated with renal function changes in patients with hypertension. Homocysteine levels were associated with serum creatinine and blood urea nitrogen (BUN) levels with coefficients of 2.04 and 0.07, respectively, only in males and independent of confounders. In addition, low density lipoprotein cholesterol (LDL-C) levels were positively and left ventricular ejection fraction (LVEF) was negatively associated with serum creatinine level in males; age was positively associated with serum creatinine levels in females. Age was a common risk factor positively associated with BUN levels in both sexes, while total cholesterol (TC) levels and glycemic control were independent risk factors that were positively associated with BUN levels only in males. LDL-C levels and LVEF were negatively associated with BUN levels in females. Body mass index (BMI) was positively associated and hemoglobin A1c (HbA1c) levels, high density lipoprotein cholesterol (HDL-C) levels and the presence of stroke were negatively associated with serum uric acid levels in male patients. In contrast, only LVEF was positively associated with uric acid levels in females. In conclusion, homocysteine level is an independent risk factor associated with serum creatinine and BUN levels in male patients with hypertension.

Long-term clinical course and outcomes of immunoglobulin G4-related lung disease

BackgroundImmunoglobulin G4-related lung disease (IgG4-RLD) is the pulmonary manifestation of a systemic fibroinflammatory disease characterized by lymphoplasmacytic infiltration with an abundance of IgG4-positive plasma cells. Long-term clinical course and outcomes of IgG4-RLD remain unclear. We aimed to identify clinical characteristics, treatment outcomes, and longitudinal pulmonary function changes in patients with IgG4-RLD according to the radiologic classification.MethodsChest computed tomography findings of 37 subjects were classified into five subtypes: solid nodular, bronchovascular, alveolar interstitial, round ground glass opacity, and alveolar consolidative. Radiologic treatment outcomes and longitudinal pulmonary function changes were compared among the different radiologic subtypes.ResultsThe mean age of the subjects was 55.6 years, and 78.4% were male. Among the five radiologic subtypes, alveolar consolidative and solid nodular type were most common, accounting for approximately 29.7% each of the total cases. Prednisone with or without azathioprine was administered to 31 patients (median treatment duration 14 months). In the treated patients, serial images showed complete response or partial response in 77.4%. However, relapse was documented in 25.0% of those who showed complete or partial response. In patients whose longitudinal lung function data were available (n = 20), the lung function was found to be stable during follow-up. Alveolar consolidative type showed the highest complete response rate, whereas alveolar interstitial type showed the lowest response rate, either complete or partial.ConclusionsMost patients showed a favorable outcome with regards to radiologic improvement and maintenance of pulmonary function; however, the response differed according to the radiologic subtype.

Liver Function Changes in Patients with Hepatocellular Carcinoma Treated with Lenvatinib: Predictive Factors of Progression to Child-Pugh Class B, the Formation of Ascites and the Candidates for the Post-Progression Treatment.

Simple SummaryMany drugs has become available for the advanced hepatocellular carcinoma and sequential systemic therapies play an important role in the clinical settings. Because the key eligibility criteria for post-progression treatment included the performance status of ≦1 and Child-Pugh score of ≦6, to clarify the eligibility for post-progression treatment will provide meaningful information. The aim of this multicenter retrospective study was to investigate the predictive factors of progression to Child-Pugh class B, the formation of ascites and the candidates for post-progression treatment. Authors confirmed that male, ALBI grade 1, Child-Pugh score 5 (CP5A) and BCLC early or intermediate stage were favorable factors related to sustaining liver function and the patients with ALBI grade 1 and CP5A were eligible for the post-progression treatment. Careful screening for ascites was needed in patients with low platelet count and Child-Pugh score 6.The aim of this multicenter retrospective study was to assess the change in liver function in patients with hepatocellular carcinoma treated with lenvatinib. Among 139 consecutive patients receiving lenvatinib treatment between March 2018 and July 2019, 28 patients with Child-Pugh class B and one patient with inadequate patient information were excluded. Remaining 110 patients with Child-Pugh class A were analyzed. The median age of 110 patients was 73 years (IQR 66.7–80) and 88 patients (80.0%) were men. Child-Pugh score was 5 (CP5A) and 6 (CP6A) in 58 (52.7%) and 52 patients (47.3%), and ALBI grade was 1 and 2 in 38 (34.5%) and 72 patients (65.5%), respectively. The deterioration to Child-Pugh class B was found in 43 patients (39.1%) during the lenvatinib treatment. The favorable factors related to preserving liver function were significantly shown to be male, ALBI grade 1, CP5A and BCLC early or intermediate stage in the multivariate analysis. The formation of ascites was found in 32 patients (28.6%). The significant unfavorable factors associated with the formation of ascites were found to be low platelet count and CP6A. Among the 79 patients, there were 36 (45.6%) and 11 patients (13.9%) who fulfilled the criteria for candidate for the post-progression treatment and ramucirumab treatment, respectively. The predictive factors of the post-progression treatment were shown to be ALBI grade 1 and CP5A in multivariate analysis. In conclusion, male, ALBI grade 1, CP5A and BCLC early or intermediate stage were favorable factors related to sustaining liver function and the patients with ALBI grade 1 and CP5A were eligible for the post-progression treatment. Careful screening for ascites was needed in patients with low platelet count and CP6A.

SMA - CLINICAL: P.84 Magnetic resonance imaging of muscle and motor functional changes in patients with spinal muscular atrophy treated with nusinersen

Nusinersen can treat patients with spinal muscular atrophy by modulating alternate splicing of the SMN2 gene and increasing survival of motor neuron protein levels. Since the approval of nusinersen in Japan in 2017, we have evaluated such patients to understand the changes in the clinical course after completed treatment. Currently, the factors correlating with good and poor responses to nusinersen treatment remain unclear. We retrospectively assessed the clinical outcomes of our treated cohort, in relevance to the level of muscle damage semiquantified by muscle MRI performed before the treatment.

EFEKTYWNOŚĆ EMISJI PRODUKTÓW ZNIEKSZTAŁCEŃ W MONITOROWANIU OTOTOKSYCZNOŚCI

ObjectiveThe purpose of this study is to describe hearing and auditory functional changes in patients receiving platinum-based treatments and to estimate the capacity of DPOAE and pure tone audiometry in evaluating ototoxicity as well as evaluating the risk factors of ototoxicity.DesignStandard pure tone audiometry at frequencies of 250–8000 Hz, and also at 12000 Hz and DPOAE recording were tested prior to starting chemotherapy and once again at the end of our program.Study sample56 patients receiving cisplatin and carboplatin were tested.ResultsAt the conventional frequencies, ototoxicity occurred in 6 (33%) of 18 patients who received cisplatin and in 12 (32%) of 38 carboplatin patients. Ototoxic hearing loss only at 12000 Hz occurred in 5 (28%) patients who received cisplatin and in 2 (5%) carboplatin patients. DPOAEs declined in 9 (75%) of 12 patients who received cisplatin and in 7 (44%) of 16 carboplatin patients. Increased dosage of platinum brought about hearing loss. Our study also investigated the initial hearing threshold as a risk factor for ototoxicity development.ConclusionOtotoxicity monitoring ought to be an important and valuable option in patients being treated with chemotherapy.

Valgus knee bracing may have no long-term effect on pain improvement and functional activity in patients with knee osteoarthritis: a meta-analysis of randomized trials

BackgroundKnee osteoarthritis (KOA), with a high incidence in old-age population, adversely affects their life quality. The valgus knee bracing is an important physical therapy for KOA, but its clinical effects on pain release and functional improvement remained unclear. This meta-analysis is to systematically evaluate the clinical outcomes of valgus knee bracing in patients with KOA.MethodsA meta-analysis of clinical randomized controlled trials (RCTs) on pain and functional changes in patients with KOA after using valgus knee braces. The search period was ranged from the inception of the database to May 2020. The enrolled research databases included PubMed, Embase, and Web of Science databases. Two investigators independently formulated inclusion criteria and exclusion criteria and screened and determined the final enrolled literature. Then the outcome indicators were extracted and organized from the included literature, and the risk of bias was assessed by Cochrane Handbook 5.0.1.ResultsA total of 10 articles were included in this study, including 739 patients. Eight articles were related to the visual analog scale (VAS) pain score, and the results showed that RR = − 0.29, 95% CI − 0.73, 0.15], P = 0.20; four articles were related to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score, and the results showed that RR = − 0.15, 95% CI [− 0.41, 0.11], P = 0.26; two articles were related to the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the results showed that RR = 0.58, 95% CI [− 4.25, 5.42], P = 0.81; and three articles were related to the KOOS Activities of Daily Living (KOOS-ADL), and the results showed that RR = 0.04, 95% CI [− 0.62, 0.69], P = 0.91. These results indicated that the valgus knee bracing has no statistical significance in pain and functional activity improvement of patients with KOA. The subgroup analysis showed that the follow-up time was the source of the heterogeneity of the VAS pain score.ConclusionOur current evidence suggests that valgus knee bracing may not improve pain release and function activates in KOA patients in the long-term period, but only being beneficial to the short-term rehabilitation.

Global and local reorganization of brain network connectivity in sudden sensorineural hearing loss.

Recent reports suggested that even moderate sudden sensorineural hearing loss (SSNHL) can be partly responsible for a loss of gray matter volume in the primary auditory cortex, hence reducing the capacity of the auditory cortical areas to react to sound stimulation. There is also evidence for a plastic reorganization of brain functional networks visible as enhanced local functional connectivity. The aim of this study was to use rs-fMRI, in conjunction with graph- theoretical analysis and a newly developed functional "disruption index" to study whole-brain as well as local functional changes in patients with acute and unilateral sensorineural hearing loss. No statistically significant differences in global or local network measures we found between SSNHL patients and healthy controls. However, when analyzing local metrics through the disruption index k, we found negative values for k which were statistically different from zero both in single subject analysis. Additionally, we found several associations between graph-theoretical metrics and clinical parameters.

Extended approach or usage of nasoseptal flap is a risk factor for olfactory dysfunction after endoscopic anterior skullbase surgery: results from 928 patients in a single tertiary center

The aim of this study was to compare olfactory function change in patients who underwent endoscopic skull-base surgery. A total of 928 patients were included in this retrospective study. Olfactory function was measured using the non- validated Likert scale (0â€"100), the Cross-Cultural Smell Identification Test (CC-SIT) and the butanol threshold test (BTT). Patients were divided into two groups: an endoscopic trans-sellar approach group (ETA, n = 768) and an extended endoscopic endonasal approach group (EEEA, n = 160). The ETA group was sub-divided into Nasoseptal flap (NSF) and no NSF groups. Non-validated olfactory function significantly worsened in the EEEA and ETA-NSF groups compared with that in the ETA- no NSF group for at least 6 months post-operatively. Validated olfactory impairment (BTT and CC-SIT) was also significantly worse in the EEEA and NSF groups compared with that in the ETA-no NSF group 3 months post-operatively. Additionally, the degrees of non-validated and validated olfactory deterioration were not significantly different between the EEEA and ETA-NSF groups. We also found that CC-SIT score changes were significantly impaired in tuberculum sellae meningioma patients than in craniopharyn- gioma patients. We conclude that NSF was the key factor that led to olfactory impairment after endoscopic skull-base surgery.

Exercise Triage And Program Adaptations For Cancer Survivors With Multiple Myeloma: A Case Series.

Multiple myeloma (MM) is associated with fracture risk and deconditioning. Exercise training can attenuate functional declines, but the safety of exercise in this population remains unclear. PURPOSE: This case series explores the clinical history, considerations for triage, program adaptations, and functional changes in patients with MM taking part in the Alberta Cancer Exercise (ACE) study. METHODS: An exercise physiologist screened cases using a cancer-specific intake and the PAR-Q+. Due to MM diagnosis, physician approval was required for entry into the ACE study. ACE involved 60 mins of community or clinic-based exercise 2x/wk for 12 weeks. Pre/post measures included the 6-Minute Walk Test (6MWT), 30s sit-to-stand, sit and reach, and optional max bench press (1RM) and plank tests. RESULTS: CASE 1: 54-year old male on chemotherapy with a history of lytic lesions throughout the thoracic cage and pelvis, and radiation therapy (RT) to large lytic lesions in the pelvis and left clavicle. Goal: improve fitness for upcoming stem cell transplantation (SCT). Physician recommendation: controlled low loading due to fracture risk. Approved for community (1x/wk) and clinic-based (1x/wk) exercise. CASE 2: 37-year old female diagnosed with MM without bone involvement, receiving chemo and targeted therapy. She had undergone surgery and was recovering from a SCT. Goal: reduce fatigue and improve fitness. Approved for clinic-based exercise with transition to community after 12 wks. CASE 3: 54-year old female on maintenance chemo with multiple lytic lesions, history of cervicothoracic decompression, reduction and instrumentation C5-T3, and prior RT to spine and pelvis. Goal: improve fitness, strength and health. Approved for clinic-based exercise. Physician recommendation: low intensity exercise due to fracture risk and pain. No adverse events occurred and increases were seen across cases in 6MWT (8.2%, 5.6%, 9.5%), sit-to-stand (0%, 18.8%, 5.9%), sit and reach (18.6%, 56.7%, 42.2%), 1RM (4.1%, 21.4%, N/A), and plank (36.8%, 50%, N/A). CONCLUSIONS: The cases presented with unique complications and apprehension towards exercise. Presence and location of lytic lesions, fracture history and risk, surgical history, and treatment stage were key considerations for exercise triage and adaptations within the ACE program.

Post-stroke Aphasia as a Prognostic Factor for Cognitive and Functional Changes in Patients With Stroke: Ischemic Versus Hemorrhagic.

ObjectiveTo investigate the comprehensive outcomes in aphasic patients, including their cognitive and functional status after ischemic or hemorrhagic stroke. It also aimed to clarify whether aphasia is a prognostic factor for cognitive and functional improvements in stroke patients.MethodsSixty-seven ischemic or hemorrhagic stroke patients in the subacute stage who had been diagnosed with aphasia using the Korean version of Frenchay Aphasia Screening Test (K-FAST) were included in the study. Forty-six stroke patients without aphasia were used as controls. All patients were examined with the Korean version of the Western Aphasia Battery (K-WAB). Cognitive and functional assessments of the patients including the Korean version of Mini-Mental State Examination (K-MMSE), and the Korean version of Modified Barthel Index (K-MBI) were performed during admission and 4 weeks after the initial assessments.ResultsThe initial and follow-up total K-MMSE and K-MBI scores were significantly lower in aphasic patients than in non-aphasic controls. The K-WAB scores highly correlated with the total K-MMSE scores at the follow-up stage in all aphasic stroke patients. The K-WAB scores moderately correlated with the follow-up scores of the K-MBI in ischemic stroke patients but not in hemorrhagic stroke patients.ConclusionAphasia influences the cognitive and functional status of stroke patients and has a greater impact on cognitive improvement. Aphasia severity can be one of the prognostic factors for cognitive status in aphasic patients with stroke.

Cerebral structural and functional changes in diabetes mellitus

Diabetes mellitus (DM) is a metabolic disease that is accompanied by brain injury manifested as cognitive impairment (CI). Objective : to study cerebral structural and functional changes in patients with DM according to the presence of CI. Patients and methods . Examinations were made in 60 patients with type 1 DM and 60 with type 2 DM who were divided into groups according to the presence of CI. The Montreal Cognitive Assessment (MoCA test) was used to evaluate CI. Glycemia and its variability and the level of glycated hemoglobin (HbA1c) were analyzed. MRI brain images were segmented using the FreeSurfer program and the Recon-all software package. Brain functional MRI was performed using paradigms (for Broca's, Wernicke's and primary motor areas). Results and discussion . Patients with type 1 DM and CI were found to have reduced volumes of the entire white matter and the right hippocampus; those with type 2 DM had decreased gray and white matter volumes. The functional activities of the primary motor and Broca's areas were reduced by 50% in patients with types 1 and by 80% in those with type 2 when conducting the tasks. A relationship was established between disease duration, patient age, glycemic variability index, MoCA test results, and decreases in the volumes of the hippocampus and white and gray matter and in the activity of motor areas in types 1 and 2 DM. Conclusion . Gray and white matter atrophy and impaired motor area functional activity are more significant in type 2 DM. These changes are associated with CI and glycemic variability.

0073 Left Anterior Cingulate Hyperarousal During Sleep Anxiety-Inducing Emotional Tasks Performance in Patients with Insomnia Disorder

Abstract Introduction Patients with insomnia frequently experience sleep/insomnia-related anxiety; this anxiety has been associated with hyperarousal. We investigated the underlying brain function changes in patients with insomnia during emotional task performance that induced sleep/insomnia-related anxiety. Methods Functional magnetic resonance imaging (fMRI) was performed during emotional task performance in healthy individuals and patients with insomnia who met the diagnostic criteria of insomnia disorder based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and had chronic insomnia for more than 6 months. The participants underwent fMRI scanning during three types of emotional task performance—insomnia-anxiety task, reading sentences that cause insomnia-related anxiety; general-anxiety task, reading sentences that cause anxiety for everyone; and neutral task, reading neutral sentences that do not cause emotional anxiety. The images obtained from fMRI and blood oxygen level-dependent (BOLD) signal changes were compared between patients with insomnia and healthy controls. Interim analysis was performed with the data of 13 patients with insomnia and 9 controls. Results The brain activity in the left anterior cingulate was higher during insomnia-anxiety task performance than that during general-anxiety task performance in the insomnia group (voxel-wise uncorrected p &amp;lt; 0.05; cluster size, 100). In the insomnia group, the brain activity during insomnia-anxiety task performance was not lower in any brain area than that during general-anxiety task performance. Conclusion We show that patients with chronic insomnia experience sleep anxiety related with hyperarousal in the left anterior cingulate area. Additional subject recruitment and re-analysis are needed to confirm the findings of this interim analysis. Support This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2017R1D1A1B03032431).

Lung function changes in patients with chronic obstructive pulmonary disease (COPD) and asthma exposed to secondhand smoke in outdoor areas

Background Further evidence is needed on the effects that short- and long-term exposure to secondhand smoke (SHS) have on the respiratory health of patients with lung disease. Within the TackSHS project we aimed to assess the acute respiratory effects in lung function that result from short-term SHS exposure among patients with asthma and chronic obstructive pulmonary disease (COPD). Methods The study design was an intervention trial with measurements before/after exposure to SHS in legal outdoor smoking areas. We studied patients with asthma or COPD from Czechia, Ireland, and Spain. Forced spirometry, peak flow and carbon monoxide (CO) measurements were performed pre- and 24 h post- exposure. Results Overall, 60 patients were studied, 30 with asthma, and 30 with COPD; 35 (58.3%) were female. There were no significant differences observed in exhaled CO between pre- and 24 h post-exposure neither in women (p = 0.210), nor in men (p = 0.169). A statistically significant decrease in forced vital capacity (FVC) was seen, overall, in asthma participants (p = 0.02) and in forced expiratory volume in the first second (FEV1), (p = 0.02), FVC (p = 0.04) and peak expiratory flow rate (PEFR) (p = 0.04) in female asthmatic participants. The observed decreases in respiratory measurements in COPD were not significant. There were no reported increases in symptoms, respiratory medication, or use of health services 24 h after the exposure. Conclusion We conclude that acute, short-term SHS exposure had a statistically significant effect on spirometry in female asthma patients but did not significantly modify spirometric indices 24 h later in COPD patients.

Ocular surface involvement in patients with neurofibromatosis type 1 syndrome.

The aim of this study is to evaluate ocular surface morphological and functional changes in patients with neurofibromatosis type 1 (NF1). Twenty-eight patients with NF1 and 14 healthy subjects were included in this study. All participants underwent a medical history collection, a complete ophthalmological examination including slit lamp exam and assessment of best-corrected visual acuity (BCVA), corneal sensitivity, and lacrimal function (Schirmer test and fluorescein tear break-up time test). Corneal nerves' morphology and endothelial cells density were evaluated by in vivo corneal confocal microscopy (IVCM). Tear and conjunctiva epithelium samples were collected to evaluate nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) tear levels and conjunctival expression of their receptors TrkA and p75NTR. Patients with NF1 showed a significant decrease of FTBUT when compared with healthy subjects (p < 0.001). Corneal sensitivity was ≤ 50mm in 46% of NF1 patients. IVCM showed a significant increase of corneal nerve branching and of corneal endothelial cells density. No significant difference was observed between the two groups on NGF and BDNF tear levels and conjunctival expression of their receptors. This study demonstrated the presence of ocular surface changes in NF-1 patients including decrease of tear stability and of corneal sensitivity. Patients with NF1 also showed changes of corneal endothelial cells' density.

Objective assessment of nasal function changes after revision endoscopic sinus surgery in patients with recurrent sinusitis

Objective:To investigate the objective evaluation system of nasal function changes in patients with recurrent sinusitis after revision endoscopic sinus surgery. Method:Sixty patients with recurrent sinusitis underwent revision endoscopic sinus surgery. The Lund-Kennedy endoscopic sinus score and Lund-Mackay paranasal sinus CT score were performed before surgery, 3, 6 and 12 months after surgery. The saccharin test was used to evaluate the nasal mucosa ciliary moving function（nasal mucosal ciliary motor velocity） before surgery, 6 and 12 months after surgery. The correlation of objective evaluation indexes before and after surgery was analyzed. Result:The Lund-Kennedy endoscopic sinus score and Lund-Mackay paranasal sinus CT score of patients 3, 6, 12 months after surgery were lower than those before surgery（P<0.05）; The Lund-Kennedy endoscopic sinus score and Lund-Mackay paranasal sinus CT score of patients 6 and 12 months after surgery were lower than those 3 months after surgery（P<0.05）; The Lund-Kennedy endoscopic sinus score and Lund-Mackay paranasal sinus CT score of patients 12 months after surgery were lower than those 6 months after surgery（P<0.05）. The nasal mucosal ciliary motor velocity of patients 6 and 12 months after surgery was lower than that before surgery（P<0.05）; The nasal mucosal ciliary motor velocity of patients 12 months after surgery was lower than that 6 months after surgery（P<0.05）. The Lund-Kennedy endoscopic sinus score was positively correlated with Lund-Mackay paranasal sinus CT score in patients before surgery, 3, 6 and 12 months after surgery（P<0.05）; The Lund-Kennedy endoscopic sinus score was negatively correlated with nasal mucosal ciliary motor velocity in patients before surgery, 6 and 12 months after surgery（P<0.05）; The Lund-Mackay paranasal sinus CT score was negatively correlated with nasal mucosal ciliary motor velocity in patients before surgery, 6 and 12 months after surgery（P<0.05）. Conclusion:There is good correlation among the Lund-Kennedy endoscopic sinus score, the Lund-Mackay paranasal sinus CT score and the nasal mucosal ciliary motor velocity in patients with recurrent sinusitis before and after revision endoscopic sinus surgery. This study establishes an objective evaluation system for evaluating the changes in nasal function with these three indexes as the main body.