HR Group Research Articles

Hr Development Strategy In The Industrial 4.0 Revolution In The Pandemic Of Covid-19

The era of the industrial revolution 4.0 is an absolute and unavoidable phenomenon in the business world. The survival of a company depends on the strategy devised to be able to carry out transformation and innovation to deal with it. So that companies and businesses that have been built are not crushed by the times and are hampered by their development, the company must be responsive to existing changes, especially with the development of technology and digital business. The company must also have an integrated travel map so that the direction of business development is clearly visible. The Covid-19 pandemic has changed many things of life in an instant. Never before in modern human history has a pandemic progressed and spread rapidly like Covid-19. Therefore, every event, response, and reaction is also oftentimes good. It happens at the individual level, the smallest community, up to the State and nation. Organizations and corporations are also forced to adapt quickly to very high levels of uncertainty. With the incessant change of life lines into all-digital. Therefore, companies really need to prepare reliable human resources and technology literacy in order to continue to achieve success. Employees should be supported and encouraged to continue learning and increase their knowledge of technology. Because the workforce or human resources who are able to apply and control technology in the present are able to move forward. This study aims to analyze the effect of human resource competence and the use of information technology in the Industrial Revolution Era 4.0 during the co-19 pandemic. In this study using the theory of Computer Mediated Communication (CMC) to examine more in how the process of forming HR groups in the advertising agenda through digital media and also the process of interaction developed by the HR groups. The method in this study uses a qualitative research method with a Case Study approach and the paradigm used is the constructivist paradigm, which is to examine how the interaction and role of HR in the interaction and communication groups in the online media. In this study trying to identify the personalities of each grouped as tourists, mingles, and devotes. Data collection is done by using observation and also conducting in-depth interviews. In addition, the data analysis technique used is to use a flow model from Miles and Huberman consisting of 3 stages, namely Data Reduction, then the presentation of data, and drawing conclusions.

Physical activity is not associated with feelings of mental energy and fatigue after being sedentary for 8 hours or more

The objective of this study was to examine the associations between physical activity (PA) and sedentary behavior (SB) on feelings of: 1) mental energy (ME), 2) physical energy (PE), 3) mental fatigue (MF) and 4) physical fatigue (PF) in participants who report sitting for less than 8 h (<8 h) compared to those who report sitting for greater than 8 h (>8 h) during the initial lockdown phase of the COVID-19 pandemic. Using a longitudinal study design, we measured PA and SB using the International Physical Activity Questionnaire-Short Form (IPAQ0SF) and feelings of ME, PE, MF, PF and fatigue using the Trait-State Mental and Physical Energy and Fatigue Questionnaire. Participants were then split into 2 groups, <8hr and >8hr. A series of step-wise regression models were used controlling for demographic factors and other lifestyle factors (e.g. sleep, mental workload, diet). Among the 473 participants in the <8hr group, PA was associated with increased PE and ME and decreased MF. However, of the 366 participants in the >8hr group PA was only associated with increased PE and decreased PF. We found PA was not significantly associated with ME and MF for participants who reported sitting >8hr. Our results suggest that sitting for >8hr may negate the positive benefits of PA on ME and MF. We recommend that individuals with low levels of ME and MF and who sit for >8hr to prioritize reducing their sitting time. For individuals with low levels of PE or PF, increasing PA is likely beneficial regardless of SB.

Prospective changes in sleep problems in response to the daily rest period among Japanese daytime workers: A longitudinal web survey.

SummaryThe daily rest period (DRP) is the daily inter‐work interval and can include a sleep opportunity, leisure time, and other non‐work time. A longer DRP may allow workers to increase time in bed (TIB) and adjust sleep timing, and that may reduce sleep problems such as short sleep duration, sleep debt, social jetlag, and poor sleep quality. The present study examined the longitudinal association between the DRP and these sleep problems among Japanese daytime workers. The DRP, TIB on workdays, sleep quality (Pittsburgh Sleep Quality Index [PSQI]), sleep debt and social jetlag were measured in November 2016 (n = 10,000) and February 2019 (n = 3,098). Of these, 955 permanent daytime workers were divided into five groups based on the change in the DRP duration: shortened ≥2 hr, shortened ≥1 hr, no change (<1 hr), extended ≥1 hr and extended ≥2 hr. Linear mixed‐model analysis revealed significant interaction (group × time) effects on the TIB, PSQI score and sleep debt (all p < 0.001), but not on social jetlag (p = 0.476). Post hoc comparisons revealed that the TIB was decreased, and the sleep debt was increased in the shortened ≥2 hr group, whereas the TIB was increased and PSQI score was improved in the extended ≥2 hr group (all p < 0.01). These findings suggest that an extension of the DRP improves sleep quantity and quality but not sleep debt and social jetlag. Aside from extending the DRP, ensuring a sufficient sleep duration and adjusting sleep timing during the DRP may also be needed to prevent sleep problems.

Central Nervous System Relapse in HIV Positive Patients Affected By Diffuse Large B Cell Lymphoma. Is the CNS-IPI Score Useful in This Population?

▪Background:Central nervous system (CNS) relapse is an important and most often fatal event in patients (pts) affected by Diffuse Large B cell lymphoma (DLBCL). Identifying high risk pts is critical to guide diagnostic and therapeutic approach.Recently, Schmitz et al. validated a risk score (CNS-IPI) that predicts the risk of CNS recurrence/progression in pts affected by DLBCL treated according to standard chemotherapy. It includes IPI score and kidney and/or adrenal glands involvement (scored 1 point if present or 0 if absent). Three levels of CNS recurrence/progression risk are defined: low (LR: 0-1 points), intermediate (IR: 2-3 points), high (HR: 4-6 points) showing significantly different rates of CNS disease at 2-years follow-up (0,6% for LR group, 3,4% for IR group, and 10.2% for HR group).This score has been validated in HIV negative population. Since DLBCL are more aggressive and at higher risk of CNS relapse/progression in HIV positive (HIV+) pts, studies of the validity of CNS-IPI score in this setting are particularly needed.The aim of our study was to evaluate the rate of CNS relapse in our HIV+ population as regard to CNS-IPI score. Furthermore, we evaluated if HIV-related parameters (such as CD4+ T cell count and HIV-RNA at lymphoma diagnosis) could influence the risk of CNS relapse.Methods: Observational, multicenter, cohort study involving 6 centres in Lombardy, Italy. HIV+ pts with DLBCL diagnosis observed from 2009 to 2015 were included in this analysis. The CNS relapse risk was estimated for all pts based on the CNS-IPI score (LR, IR, HR). Continuous variables were described by median values and first and third quartiles. Chi-square or Fisher's exact test and Kruskal-Wallis test were used for comparison of discrete and continuous variables, respectively.Results: Sixty-one HIV+ pts with DLBCL were included. General characteristics of population showed: 90% male; median age 49 years; median CD4+ T cell count at lymphoma diagnosis 224 cells/mm3; median HIV-RNA log10 4.2; 34% HCV Ab pos; 70.5% on antiretroviral treatment (ART) at the onset of DLBCL; 93.4% treated with R-CHOP like regimen and 6.6% pts with higher-intensity chemotherapeutic regimen; 54% with IPI ≥3 and 46% with IPI <3; 19.7% pts underwent intratechal (IT) prophylaxis. According to CNS-IPI score we defined 13 pts (21,3%) at HR of CNS relapse, 38 pts (62,3%) at IR and 10 pts (16,4%) at LR of CNS relapse. Pts belonging to HR group displayed significantly higher number of extranodal sites (84.6% showing 2-4 extranodal sites) as compared to IR and LR groups (20% and 0% showing 2-4 extranodal sites, respectively, p=0.03). In addition, pts with HR score showed a poor ECOG PS (61.5% showing >2) as compared to intermediate and low CNS relapse risk (20% and 20% showing ECOG PS >2, respectively, p=0.01).In our series, we didn't find any significant association among HIV-related characteristics at lymphoma diagnosis (CD4+ T cell count, nadir CD4+ T cell count, HIV-RNA log10, use of ART) and CNS-IPI risk score. After a median follow-up of 28 months (range 4-96), 6 pts (9.8%) displayed a CNS relapse. We found that CNS relapse was significantly more frequent in CNS-IPI HR pts (4/13, 30.8%) as compared to CNS-IPI IR or LR pts (2/30, 6.7% and 0/10, 0%, respectively, p=0.049). No association was found between HIV-related characteristics and CNS relapse. The risk of death was also significantly higher in CNS-IPI HR group (69.2%) as compared to IR and LR groups (33.3% and 0%, respectively, p<0.0001). As shown in Figure 1, all CNS relapses occurred in the first 12 months after diagnosis. No association was found between IT prophylaxis and CNS relapse, even if very few pts underwent this procedure.Discussion: In our study we found that CNS-IPI score could be considered as a valuable prognostic tool of CNS relapse/progression also in HIV+ pts. We found a higher rough proportion of DLBCL pts belonging to HR CNS-IPI group in our HIV+ cohort as compared to published data on general population, even if no relationship emerged between HIV-related parameters and CNS relapse risk. Further studies on larger HIV+ population are required to confirm the validity of this score; moreover, the integration of HIV-specific markers and histological characteristics of DLBCL could ameliorate the therapeutic approach and finally reduce the risk of CNS disease in HIV+ population. [Display omitted] DisclosuresGambacorti-Passerini:Pfizer: Consultancy, Honoraria, Research Funding; BMS: Consultancy.

Chronic Lymphocytic Leukemia International Prognostic INDEX (CLL-IPI) Predicts Prognosis of CLL: A Systematic Review and Meta-Analysis

Background : The chronic lymphocytic leukemia international prognostic index (CLL-IPI) was first reported in 2015 and published in 2016 (Lancet Oncology 17:779). The utility of this prognostic tool has been confirmed in independent validation studies across countries and in different practice settings (i.e., clinical trials, academic medical centers, national population based cohorts). However, there are subtle differences of median survival of each risk category across series and limited information is available on the utility of the tool to predict time from diagnosis to first treatment (TTFT). To increase understanding of these important clinical questions, we conducted a systematic review and meta-analysis which includes all published studies that have used CLL-IPI to predict clinical outcome of CLL.Material & Methods : A systematic literature search was performed using PubMed to identify full length reports on the utility of the CLL-IPI reported prior to June 30, 2017. The search strategy used both Medical Subject Headings (MESH) terms and free text words to increase the sensitivity. The electronic search yielded 9 records including 7 full-text articles assessed for eligibility. A complementary manual search of the ASH, EHA and ASCO conference proceedings identified 3 additional citations.Results: In total 12 series including 7909 patients analysed the impact of CLL-IPI on overall survival (OS). The patient distribution into the CLL-IPI risk categories was as follows: low-risk [LR], median, 45.9%[range, 1.3-58%]; intermediate-risk [IR], median, 30% [range,8.2-39%]; high-risk [HR], median, 16.5% [range, 12.6-56%]; very high-risk [v-HR], median, 3.6% [range, 2.2-40.8%]. The wide range of distribution across CLL-IPI risk categories reflects differences of the point in the course of the disease at which CLL-IPI was assessed in the different studies (i.e., at diagnosis [8 studies], at time of first treatment [3 studies] and at relapse [one study]). The 5-year survival probability was 92% for LR CLL-IPI (95% CI, 90-93%), 81% for IR CLL-IPI (95% CI, 80-83%), 60% for HR CLL-IPI (95% CI, 58-63%) and 34% for v-HR CLL-IPI (95% CI, 29-40%)(Fig 1a). Values of the “Q” or “I2” test suggest a certain degree of heterogeneity across different studies (i.e., [LR], Q=63.9, P< 0.001; I2= 84%; [IR], Q=59.8, P<0.001, I2= 83%; [HR], Q=49.7, P<0.001,I2= 80%; [v-HR], Q=27.4, P=0.001, I2= 67%).TTFT was evaluated in 9 studies including 5206 patients. The probability of remaining free from therapy at 5 years on pooled meta-analysis was 82% (95% CI: 80-83%) in the LR group, 45% (95% CI: 43-48%) in the IR group, 30% in the HR group (95% CI: 26-33%) and 16% in the v-HR group (95% CI: 10-22%)(Fig 1b). Notably, the heterogeneity in TTFT across different studies was greatest among patients of LR (Q=38.8,P<0.001;I2 =79%) and IR CLL-IPI (Q=27.0, P<0.001; I2 =70%) but significantly decreased among patients of HR (Q=14.4,P=0.57; I2 = 45%) and v-HR CLL-IPI (Q=1.65,P=0.95; I2 =0%) indicating more consistent TTFT outcomes among the HR and v-HR groups across studies.Conclusions: In this comprehensive review and meta-analysis of studies published on CLL-IPI to date, we confirmed the value of the CLL-IPI as a robust tool to predict OS and TTFT. Although CLL-IPI simply prognosticates CLL and integrates multiple factors into a single risk score, further prospective evaluation of this tool in the era of B-cell receptor and bcl-2 inhibitors are needed. [Display omitted] DisclosuresMolica:Roche: Other: Advisory Board; Jansen: Other: Advisory Board; AbbVie: Other: Advisory Board; Gilead: Other: Advisory Board. Shanafelt:Jannsen: Research Funding; GlaxoSmithKline: Research Funding; Genentech: Research Funding; Celgene: Research Funding; AbbVie: Research Funding; Pharmacyclics: Research Funding; Hospira: Research Funding.

Distinct Outcome Based on Fusion Transcript in t(16;21) Rearranged Pediatric AML, a Collaborative Retrospective Analysis By the I-BFM SG

Despite the use of of intensive chemotherapy, and allogeneic stem cell transplant (HSCT) in selected cases, children with acute myeloid leukemia (AML) have 5-year overall survival (OS) rates of ~65%. Apart from early clinical response, cytogenetic and molecular aberrations are the most reliable prognostic factors for survival. Identifying prognostic subgroups to stratify patients for treatment in future trials is clinically important. The study of rare AML subtypes can be facilitated by international collaborations. AML with t(16;21) rearrangements includes 2 different translocations: t(16;21)(p11;q22) resulting in the FUS-ERG fusion, and t(16;21)(q24;q22) resulting in the RUNX1-CBFA2T3 fusion.To study outcomes and associated prognostic factors, clinical data from children with t(16;21) AML were collected from 14 study groups participating in the international Berlin-Frankfurt-Munster (I-BFM) network. Patients (age 0-18 years) diagnosed from January 1, 1995, to January 1, 2016, were included. The AML-BFM study group provided data from 1326 unselected patients diagnosed between 1997 and 2013 as a reference cohort. All karyotypes were centrally reviewed by 2 independent cytogeneticists according to the International System for Human Cytogenetic Nomenclature (ISCN 2005). Patients with inconclusive karyotypes were screened by reverse-transcription PCR. Chi-squared and Fisher exact tests were used to compare clinical characteristics. OS and event free survival (EFS) analysis was performed by the Kaplan-Meier method. Cumulative incidence of relapse (CIR) was calculated according to Kalbfleisch and Prentice. The Cox proportional hazards model was used for multivariate analysis, considering as covariables age, white blood cell (WBC) count at diagnosis, cytogenetic risk group and allogeneic hematopoietic stem cell transplantation (HSCT) as time-dependent variable.There were 54 patients with t(16;21): 32 with FUS-ERG and 22 with RUNX1-CBFA2T3 . There were no significant differences in sex and age between patients in the FUS-ERG- or RUNX1-CBFA2T3- groups and the reference cohort. Median WBC at diagnosis was significantly lower for patients with RUNX1-CBFA2T3 (12.5×109/L, range 0.01-185×109/L) than for the reference cohort (19.4×109/L, range 0.01-1900×109/L, P=0.030). Patients with FUS-ERG had no predominant French-American-British (FAB) type, whereas 76.4% of those with RUNX1-CBFA2T3 had a granulocytic FAB type (M1, M2) compared with 42.1% in the reference cohort (P=0.004).The 4-year EFS, OS, and CIR for the reference cohort were 51% [standard error (SE)=1%], 68% (SE=1%), and 32% (SE=1%), respectively. Median follow up for survivors in the t(16;21) cohort was 1.6 years for those with FUS-ERG and 5.0 years for RUNX1-CBFA2T3 . Patients with FUS-ERG had a 4-year EFS of 7% (SE=5%, P <0.0001), 4-year OS of 21% (SE=8%, P <0.0001), and CIR of 74% (SE=8%, P <0.0001). Patients with RUNX1-CBFA2T3 had a 4-year EFS of 77% (SE=9%, P=0.06), OS of 81% (SE=8%, P=0.34) and a CIR of 0%. When patients in the reference cohort were classified in SR patients comprising (inv(16)/t(8;21), and HR patients comprising other cytogenetic subtypes excluding t(16;21), EFS rates were 74% (SE=3%) and 45% (SE=2%), respectively (Fig. 1). Hence, patients with RUNX1-CBFA2T3 had a similar outcomes as SR patients (Figure 1). In multivariate analysis, presence of FUS-ERG and RUNX1-CBFA2T3 were independent risk factors for EFS, with hazard ratios of 1.93 (P <0.0001) and 0.325 (P=0.025), respectively. HSCT was performed in 14 (45.2%) patients with FUS-ERG in first complete remission (CR1). The 4-year EFS for transplanted patients was 15% (SE=15%) compared with 0% (SE=13%) for patients receiving chemotherapy only (p=NS).We identified 2 clinically relevant, distinct subtypes of pediatric AML patients with different t(16;21) rearrangements: FUS-ERG had poor outcomes, whereas RUNX1-CBFA2T3 had favorable outcomes. Patients with RUNX1-CBFA2T3 -rearranged AML might benefit from inclusion in the SR group and receiving less intensive treatment, whereas those with FUS-ERG rearranged AML should be stratified in the HR group. In this study, only patients with FUS-ERG receiving HSCT in CR1 did not relapse. Most current pediatric AML trials consider children with a 5-year OS below 25%-30% for HSCT in CR1. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Geltamo-IPI Distinctly Identifies a Very High Risk Group in Difuse Large B-Cell Lymphoma (DLBCL) of Non B-Germinal-Center Origin Treated with Chemo-Immunotherapy

▪Backgound. GELTAMO-IPI has shown to have better prognostic effect than NCCN-IPI for DLBCL treated with immunochemotherapy (BJH;2017;176;918) with the additional advantages to identify a real high risk group and not being influenced by the primary extranodal presentation or the use of treatment more intense than R-CHOP. The variables in GELTAMO-IPI and its statistical weight are: age (<65 years: 0 points; ≥65-79:1 pt.; ≥80 2 pt.), PS (0-1: 0 p.; 2: 1pt. ≥2: 2 pt.), >LDH, > β2mcg and stage IV, one point each. The combination of these factors separate four risk groups, Low risk (LR, 0 points), Low-Intermediate risk (LIR, 1-3 points), High-Intermediate risk (HIR, 4 points and High Risk (HR≥5 points), with 5-year overall (5y-OS) survival of 93%, 79%, 66% and 39%, respectively.Aims. Present study explores the prognostic effect of GELTAMO-IPI in the histological subgroups depending of the cell of origin: B Germinal Center (BGC) or non B Germinal Center (Non-BGC).Methods. the original series for the development of GELTAMO-IPI comprised 1848 patients. The BGC/non-BGC origin was calculated with the Hans algorithm by the Immunohistochemical expression of 3 markers (CD10, BCL6 and MUM-1) being available in 1097 patients. The statistical study consisted in the development of a Cox model which includes the three variables: GELTAMO-IPI groups (LR, LIR, HIR, HR), cell of origin (BGC/non-BGC) and its product in order to evaluate the presence of interaction between these variables. Kaplan-Meier and Log-rank were used for survival curves and comparison.Results. The cell of origin was retrieved in 1097 patients: 380 BGC, 459 non-BGC and 258 non-evaluable. The series includes: LR 72 p. (9.2%), LIR 464 p. (59.5%), HIR 127 p. (16.3%) and HR 117 p. (15%) with 5y-OS of 98%, 79%, 67% and 41%, respectively. The Cox model showed interaction between the risk groups and the GBC/non-GBC origin (p=0.005), indicating that GELTAMO-IPI has a different effect in each group. In the BGC-DLBCL group with LR (34 p.), LIR (221 p.), HIR (53 p.) and HR (45 p.) the 5y-OS differences between LR and LIR are maintained (100%, 75%, respectively), but not between HIR and HR (53% and 51%); Nevertheless, GELTAMO-IPI stratified 3 distinct risk groups (LR, LIR and HIR+HR), although it is not able to identify a real high risk group of patients (Figure 1, left panel). In the Non-BGC-DLBCL the differences among the LR, LIR and HIR groups (38, 243, and 74 patients with 5y-OS of 97%, 82% and 77%) have lower significance than in the original study (p=0.01 and p=0,26, respectively), but a distinct HR group of 72 patients with a 5yOS of 35% is clearly identified (p<0.001) (Figure 1, right panel).Conclusions. GELTAMO-IPI separates three risk groups in BGC-DLBCL, but fails to identify a genuine HR group, whereas GELTAMO-IPI in the non-BGC-DLBCL positively identifies a real high risk group. This different outcome in the GC-DLBCL and non-GC-DLBCL using simple clinical factors, as included in GELTAMO-IPI, represents an interesting practical prognostic tool in the clinical practice. [Display omitted] DisclosuresDiaz-Lopez:TFS: Employment. Martín:Gilead: Consultancy; Janssen: Honoraria; Servier: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Roche: Consultancy, Honoraria. Sancho:Roche: Honoraria; Gilead: Honoraria; Celgene: Honoraria; Janssen: Honoraria; Laboratorios Servier: Consultancy; Kern Pharma: Honoraria; Mundipharma: Honoraria. Salar:Servier: Speakers Bureau; Janssen: Speakers Bureau; Roche: Speakers Bureau. Gutierrez:JANSSEN: Consultancy, Research Funding, Speakers Bureau; ROCHE: Research Funding, Speakers Bureau; SERVIER: Speakers Bureau; GILEAD: Honoraria; TAKEDA: Speakers Bureau; PFIZER: Consultancy. Lopez-Guillermo:Janssen: Consultancy; Gilead: Consultancy; Celgene: Consultancy; Roche: Consultancy, Other: Research grant; Novartis: Consultancy.

Caloric Restriction Prevents Metabolic Dysfunction and the Changes in Hypothalamic Neuropeptides Associated with Obesity Independently of Dietary Fat Content in Rats.

Energy restriction is a first therapy in the treatment of obesity, but the underlying biological mechanisms have not been completely clarified. We analyzed the effects of restriction of high-fat diet (HFD) on weight loss, circulating gut hormone levels and expression of hypothalamic neuropeptides. Ten-week-old male Wistar rats (n = 40) were randomly distributed into four groups: two fed ad libitum a normal diet (ND) (N group) or a HFD (H group) and two subjected to a 25% caloric restriction of ND (NR group) or HFD (HR group) for 9 weeks. A 25% restriction of HFD over 9 weeks leads to a 36% weight loss with regard to the group fed HFD ad libitum accompanied by normal values in adiposity index and food efficiency ratio (FER). This restriction also carried the normalization of NPY, AgRP and POMC hypothalamic mRNA expression, without changes in CART. Caloric restriction did not succeed in improving glucose homeostasis but reduced HFD-induced hyperinsulinemia. In conclusion, 25% restriction of HFD reduced adiposity and improved metabolism in experimental obesity, without changes in glycemia. Restriction of the HFD triggered the normalization of hypothalamic NPY, AgRP and POMC expression, as well as ghrelin and leptin levels.

Curcumin pre-treatment may protect against mitochondrial damage in LRRK2-mutant Parkinson's disease and healthy control fibroblasts

Mitochondrial dysfunction has been proposed as one of the pathobiological underpinnings in Parkinson's disease. Environmental stressors, such as paraquat, induce mitochondrial dysfunction and promote reactive oxygen species production. Targeting oxidative stress pathways could prevent mitochondrial dysfunction and thereby halt the neurodegeneration in Parkinson's disease. Since curcumin is touted as an antioxidant and neuroprotective agent, the aim of this study was to investigate if curcumin is a suitable therapy to target mitochondrial dysfunction in Parkinson's disease using a paraquat-toxicity induced model in fibroblasts from LRRK2-mutation positive Parkinson's disease individuals and healthy controls. The fibroblasts were exposed to five treatment groups, (i) untreated, (ii) curcumin only, (iii) paraquat only, (iv) pre-curcumin group: with curcumin for 2hr followed by paraquat for 24hr and (v) post-curcumin group: with paraquat for 24hr followed by curcumin for 2hr. Mitochondrial function was determined by measuring three parameters of mitochondrial respiration (maximal respiration, ATP-associated respiration, and spare respiratory capacity) using the Seahorse XFe96 Extracellular Flux Analyzer. As expected, paraquat effectively disrupted mitochondrial function for all parameters. Pre-curcumin treatment improved maximal and ATP-associated respiration whereas, post-curcumin treatment had no effect. These findings indicate that curcumin may be most beneficial as a pre-treatment before toxin exposure, which has implications for its therapeutic use. These promising findings warrant future studies testing different curcumin dosages, exposure times and curcumin formulations in larger sample sizes of Parkinson's disease and control participants.

Effect of Hyperbaric Oxygen Therapy Initiation Time in Acute Carbon Monoxide Poisoning.

Hyperbaric oxygen therapy (HBO2) is recommended for symptomatic patients within 24-hour postcarbon monoxide poisoning. Previous studies have reported significantly better outcomes with treatment administered within 6 hours after carbon monoxide poisoning. Thus, we aimed to compare the neurocognitive outcomes according to HBO2 delay intervals. Retrospective analysis of data from our prospectively collected carbon monoxide poisoning registry. A single academic medical center in Wonju, Republic of Korea. We analyzed the data of 706 patients older than 16 years treated with HBO2 with propensity score matching. Based on carbon monoxide exposure-to-HBO2 delay intervals, we classified patients into the early (control, less than or equal to 6 hr) and late (case, 6-24 hr) groups. The late group was further divided into Case-1 (6-12 hr) and Case-2 (12-24 hr) groups. We also compared mild (nonintubated) and severe (intubated) groups. HBO2. After propensity score matching, Global Deterioration Scale scores at 6 months postcarbon monoxide exposure showed significantly fewer poor outcome patients in the early than in the late group (p = 0.027). The early group had significantly fewer patients with poor outcomes than the Case-2 group (p = 0.035) at 1 month and than the Case-1 (p = 0.033) and Case-2 (p = 0.004) groups at 6 months. There were significantly more patients with poor prognoses at 6 months as treatment interval increased (p = 0.008). In the mild cohort, the early group had significantly fewer patients with poor 6-month outcomes than the late group (p = 0.033). Patients who received HBO2 within 6 hours of carbon monoxide exposure had a better 6-month neurocognitive prognosis than those treated within 6-24 hours. An increase in the interval to treatment led to an increase in poor outcomes.

Comparison of the TightRope system versus hook plate in acute acromioclavicular joint dislocations: a retrospective analysis

This study compared the results of the minimally invasive coracoclavicular (CC) fixation with a single TightRope (MITR) procedure and the hook plate (HP) procedure for acute acromioclavicular (AC) joint dislocation treatment. Sixteen patients with a mean age of 44.9 ± 11 years were treated with the MITR procedure. Nineteen patients with a mean age of 40.2 ± 8.7 years were treated using the HP procedure. Clinical outcomes were evaluated with the Visual Analog Scale (VAS) for pain, Constant–Murley Score (CMS), and University of California at Los Angeles (UCLA) Shoulder score. Vertical displacement of the clavicle with reference to the height of the acromion was measured in standard anteroposterior radiographs. The mean follow-up was 27 months in the MITR group and 30 months in the HP group. No statistically significant differences were found between the MITR group and the HR group in terms of VAS score (0.4 ± 0.6 vs 0.7 ± 0.6, P = 0.138), UCLA Shoulder score (33.9 ± 2.5 vs 33.7 ± 1.5, P = 0.843), or CMS (95.7 ± 7.3 vs 93.7 ± 6.6, P = 0.400). No redislocation was identified in the HP group, while redislocation occurred in 1 of 16 (6.3%) patients in the MITR group. One patient in the HP group (5.3%) had acromial osteolysis, while no acromial osteolysis was found in the MITR group. No other adverse events, such as infections, tunnel widening, fractures, or implant-related complications, were observed. Both procedures provided satisfactory results. The HP procedure provided better reduction, while the MITR procedure provided a slightly lower tendency of pain. Long-term follow-up is needed to investigate the clinical outcomes and radiological outcomes of both groups.

Effects of Desflurane Versus Propofol Anesthesia on Regional Cerebral Oxygenation during Spinal Surgery in the Prone Position

Context: Postural change during anaesthesia has a complex effect on systemic and cerebral circulations. Aim: The goal of the study was to evaluate the effects of desflurane and propofol on cerebral oxygenation during spinal surgery in the prone position. Settings and Design: A prospective randomized double-blinded trial. Methods and Materials: Fifty-two patients scheduled for spinal surgery were randomly allocated to propofol (n=25) and desflurane (n=27) groups. Anaesthetic agents were maintained to obtain a bispectral index of 50-55. SAP, DAP, HR, SPO2, ETCO2 and right and left rSO2 were assessed at seven-time points: supine position without oxygen administration (T1), supine position with oxygen administration (T2-baseline), intubation in the supine position (T3), just after prone positioning (T4), 10 minutes after prone positioning (T5), at the end of surgery in the prone position (T6) and at the end of anaesthesia in the supine position (T7). PCO2, PO2 and Hb partial were also recorded at T3 and T7. Results: Demographic data, pre-oxygenation hemodynamic variables and rSO2 were comparable between the groups. There was no significant difference between groups in SAP, DAP, HR, SPO2, and ETCO2 (p=0.095, p=0.061, p=0.357, p=0.088, p=0.328 respectively). PCO2, PO2 and Hb were not significant different between groups (p=0.542, p=0.394, p=0.768 respectively). rSO2 values were not significantly different between groups. In the propofol group, right rSO2 was significantly higher at T3 (p=0.017) and significantly lower at T5 (p=0,019) and at T6 (p=0,028) compared to baseline. Left rSO2 decreased significantly from baseline at T5 (p=0.026) in the propofol group. Left and right rSO2 in the desflurane group decreased significantly from baseline at T5 (p=0.0004 and p=0.0115). Conclusion: In the prone position, desflurane and propofol were associated with a significant decrease in rSO2 without differences between these anaesthetics.

421 Elucidating Circadian and Sleep Phenotypes and Relation to Cognitive Impairment in Alzheimer’s Dementia

Abstract Introduction Although sleep disruption in Alzheimer’s disease (AD) pathogenesis has been described, the role of circadian rhythm dysfunction (CRD) is less understood. We hypothesize greater CRD and sleep disruption with poorer cognitive function in AD compared to normal cognition. Methods We examined 3 groups:1)mild cognitive impairment with positive AD biomarkers(MCI-AD),n=18, 2)cognitively normal at high risk for AD(HR)(APOEƐ4 carriers),n=19, 3)cognitively normal APOEƐ4 non-carriers(CL),n=16 (National Institute of Aging, IMMUNE-AD). DNA extraction and APOEƐ4 genotyping were performed under the Cleveland Clinic Lou Ruvo Center for Brain Health Aging and Neurodegenerative Disease Biobank. We evaluated actigraphy-based (Motionlogger MicroWatch, Ambulatory Monitoring,Inc®) sleep (wake episodes(WE), total sleep time(TST), sleep efficiency(SE), sleep fragmentation index(SFI)) and circadian (mesor, amplitude, robustness, sleep regulatory index(SRI), intradaily stability) predictors and sleep study-based (ApneaLink Air by ResMed®) predictors (apnea hypopnea index(AHI,3% desaturation) and recording time&amp;lt;90%SaO2) across the groups and assessed association with cognition (Mini-Mental State Exam(MMSE)). Analysis of variance (ANOVA) or Kruskal-Wallis with Bonferroni adjustment was used for cross-group comparisons. ANCOVA assessed cross-group association of MMSE and sleep/circadian indices. Models were adjusted for age, sex, race, education, and BMI. Results Age differed across MCI-AD, HR, and CL groups (68.4±6.2,71.2±3.7,73.7±3.7 respectively,p=0.008). MCI-AD had more WE than HR and CL (14.4±5.6,10.9±3.9,10.9±3.5 respectively,p=0.033). In MCI-AD, the following associations were observed: 5% increase in SE was associated with 0.49 point higher MMSE (coefficient0.49, 95%CI[0.03,0.95],p=0.038), 1 hour increase in TST was associated with 0.81 point higher MMSE (coefficient0.81, 95%CI[0.24,1.37],p=0.006), and 1 unit increase in SFI was associated with 0.36 point lower MMSE (coefficient-0.36, 95%CI[-0.64,-0.08],p=0.013). Key measures differed: CLs had lower AHI, MCI-AD had less TST SaO2&amp;lt;90%, MCI-AD had the largest and HR the lowest SFI, and MCI-AD had lesser robustness but higher mesor and amplitude. Conclusion In this comparative study of carefully AD biomarker-phenotyped and APOEƐ4-genotyped patients and normal cognition controls, less sleep time and more fragmented sleep are associated with poorer MMSE scores in MCI-AD. Preliminary results show cognitively normal participants at risk of AD(HR) do not show CRD seen in MCI-AD and are more consistent with controls (CL). Support (if any) Catalyst Award. MCI cohort: Alzheimer’s Association, 2014-NIRG-305310. IMMUNE-AD, R01AG022304. CADRC, P30 AG062428. Jane and Lee Seidman Fund.

Management of Adenoid Cystic Carcinoma of the Breast: A Single-Institution Study.

ObjectiveThe purpose of our study was to analyze the clinicopathologic features and surgical and oncological outcomes of adenoid cystic carcinoma (ACC) of the breast and to provide the basis for a clinical therapeutic schedule.MethodsA total of 14 patients with primary breast adenoid cystic carcinoma treated at Cancer Hospital of the Chinese Academy of Medical Sciences from January 2000 to December 2017 were included. Data on clinical presentation, treatment strategy, and outcome, as well as the pathological features of ACC, were reviewed and analyzed.ResultsFourteen patients were diagnosed with ACC of the breast, out of 23205 total patients treated for breast cancer (0.06%). All but three patients were postmenopausal, with a median age at diagnosis of 60.5 years (range, 39–73 years). The most common clinical presentation was a palpable mass (85.7%), and the imaging characteristics of all patients on color Doppler ultrasound and mammography were nonspecific. Six patients (42.9%) were suspected of having ACC by fine-needle aspiration cytology (FNAC) and were confirmed by postoperative histology and immunohistochemistry. All 14 patients underwent surgery, and no patient had a positive lymph node status. Median tumor size was 1.75 cm (range, 1–3 cm). Eight/14 (57.1%) patients were hormone receptor negative (HR−) and HER-2/neu (−) (HER2−). The remaining patients were hormone receptor positive (HR+). There was no significant difference in clinicopathological characteristics between the HR+ group and the HR- group (P>0.05). The mean follow-up period was 57 months. Local recurrence occurred in 14.3% of patients, 1.7% of patients had distant metastasis, all patients with local recurrence or distant metastasis were in the HR (-) group, and all patients were alive at the last follow-up.ConclusionACC of the breast cannot be simply summarized as triple-negative breast cancer because it also includes a small number of hormone receptor-positive breast cancers. Establishing a preoperative diagnosis is difficult on the basis of clinical imaging examination, FNAC may be useful tool in the diagnosis. the final diagnosis can only be assessed based on the results of the histopathological and immunohistochemical examination. Breast-conserving surgery may be an alternative treatment strategy, and axillary lymph node dissection or sentinel node biopsy may not be necessary in some cases.

Efficacy of Dialectical Behavior Therapy on Decreasing Weight in Obese Women with Emotional and Behavioral Disorders: A Quasi Experimental Study

Objective: The growing worldwide prevalence of overweight and obesity, despite treatment strategies remain the health problem. Over the past decade, increasing attention has been paid to psychological factors and a potentially comprehensive, multimodal skills-based treatment. The purpose of this study was to evaluate the efficacy of dialectical behavior therapy (DBT) on weight loss in obese women with emotional and behavioral disorders. Materials and Methods: In this quasi-experimental study, statistical population from convenience sampling consisted of 42 obese women with body mass index (BMI) more than 29.9 kg/m2 divided in 3 groups, behavioral, emotional and control. Descriptive and analytic statistics were computed according to demographic information, emotional eating scale and Dutch eating behavior questionnaire. Intervention included 13 sessions of 1.5hr group therapy, DBT-skills training from April to September 2019. Mixed-effect modeling ANOVA with repeated measurements was performed by statistical analyses, IBM SPSS version 24 to study changes in variables over time. Results: The results demonstrated that the emotional such as anger, anxiety and depression, significantly decrease during the study period. (P-value&lt;0.001) As well as behavioral eating demonstrated significant improvement in restrained eating and decrease in emotional and external eating behaviors right after the end of intervention while trial group experienced significant weight loss. Conclusion: The present study provides some evidence that DBT-skills training can be effective in decreasing problematic eating behaviors, emotion dysregulations, decreasing BMI.

The brief resilience scale is associated with pre- and short-term postoperative outcomes following hip arthroscopy.

Despite improving diagnostic and surgical techniques, some patients do not respond as well as others following hip arthroscopy. In most musculoskeletal studies, predictors for surgical outcomes focus solely on physical health prior to surgery. However, there likely exists a relationship between a patient's mental health and their postoperative patient-reported outcome measures (PROMs). 40 patients who met indications for hip arthroscopy were enrolled in this prospective cohort study. All patients completed a baseline Brief Resilience Scale (BRS) and 4validated PROMs: modified Harris Hip Score (mHHS), visual analogue scale for pain (VAS), Hip Outcomes Score for Activities of Daily Living (HOS-Daily), and Hip Outcomes Score for Sports-Related Activities (HOS-Sport). For a secondary measure of psychometric evaluation, past medical histories of anxiety/depression were recorded. Patients were stratified into Low Resilience (LR < 21), Normal Resilience (NR 22-24), and High Resilience (HR > 25) by tertile to determine differences in PROMs. Comparisons and correlations of pre- and postoperative outcomes between resilience groups were performed. In comparing the LR and HR groups, there was a significant relationship between resilience and all PROMs both preoperatively and 6 months postoperatively (p < 0.05), with the exception of the HOS-Sports. Pearson Correlation Coefficients confirmed this trend in the mHHS and the HOS-Daily. Additionally, there were sixteen patients who were discharged prior to 6-month follow-up with an average resilience above the mean of total population (p < 0.0001). Resilience was associated with return to activity (p = 0.017). A past history of anxiety/depression was associated with lower resilience (p = 0.039). This study showed that HR hip arthroscopy patients had better PROMs than LR patients both preoperatively and postoperatively. HR patients were able to return to activity earlier and had lower rates of preoperative anxiety/depression. The BRS is a simple in-office screening tool, which may help guide patient and doctor communication and expectations.

Metaplastic breast cancer: Treatment and prognosis by molecular subtype

BackgroundMetaplastic breast cancer (MBC) is a rare and aggressive subtype of breast. However, the effect of molecular subtype on treatment and prognosis of MBC remains unclear. Patients and methodsThe Surveillance, Epidemiology, and End Results database was used to analyze patients with MBC between 2010 and 2016. Molecular subtype was stratified to TN group (ER and PR-/HER2-), HER2 group (ER and PR-/HER2+, ER/PR+ and HER2+), and HR group (ER/PR+ and HER2-). The breast cancer-specific survival (BCSS) differences were estimated using multivariate Cox regression model and Kaplan-Meier curves. ResultsWe included 1665 patients with median follow-up time of 27 months (range 0–83 months). 1154 (69.3%), 65 (3.9%), and 446 (26.8%) patients presented in TN group, HER2 group, and HR group, respectively. On multivariate Cox analysis, the prognosis was related to age, tumor size, regional node metastasis, and surgery. Molecular subtype remained no impact on BCSS. Radiotherapy (RT) was associated with better prognosis. Patients cannot benefit from chemotherapy. In Kaplan-Meier curve, triple-negative (P = 0.047) and HR-positive (P = 0.006) patients receiving RT had a superior BCSS than that not RT. HER2-positive patients cannot benefit from RT. However, adjusted Kaplan-Meier survival model showed that triple-negative (P = 0.019) but not HER2-positive (P = 0.575) or HR-positive (P = 0.574) patients receiving RT had a superior BCSS than that not RT. ConclusionsMolecular subtype is not associated with the better prognosis of MBC. Patients could benefit from RT. However, triple-negative but not HR-positive or HER2-positive patients have superior survival after receiving RT.

Relationship between the time from injury to surgery and the degree of fracture reduction by ligamentotaxis in a posterior instrumentation without fusion for thoracolumbar unstable burst fracture: a retrospective cohort study

Background: This study aimed to investigate the relationship between the time from injury to surgery and the degree of fracture reduction in patients with unstable thoracolumbar burst fractures who had ligamentotaxis in a surgery in which the internal fixator was removed after obtaining union of the fractures. The surgery included posterior instrumentation with pedicle screws without an intervertebral fusion. Methods: Ninety-five patients underwent posterior instrumentation that used pedicle screws without segmental fusion as well as a removal procedure for internal fixation after obtaining union of the fracture. Those patients who were followed up for at least 1 yr after removal surgery were retrospectively enrolled. At the time of the injury, vertebral body angle was measured and the difference in the two angles was termed the correction angle. Based on the duration from injury to surgery, the patients were divided into two groups: those who had surgery within 48 hr (group A) and those who had surgery after 48 hr (group B). Results: There was a significantly weak negative correlation between the correction angle and the length of time from injury to surgery when the correlation coefficient was r=−0.205. By correcting the age, correction angle, and gender as well as increasing the correction angle by 1 degree, the probability of a subject belonging to group A was increased by 1.137 times more than the probability of a subject belonging to group B (P=0.004). Conclusions: The time from the injury to surgery for unstable thoracolumbar burst fractures tends to be shorter with a younger age, and the shorter lead time will cause a weaker negative relationship with correction angle. Level of Evidence: Level III.

Visual memory improvement in adolescents at high risk for suicide who are receiving psychotherapy at a community clinic

The current study aims to: 1) investigate cognitive differences among adolescents at risk for suicide versus healthy controls (HC) and 2) identify cognitive changes associated with response to psychotherapy among adolescents at high risk for suicide. Thirty-five adolescents at high risk for suicide (HR), and 14 HC adolescents were recruited. Clinical and cognitive assessments were conducted in both groups at baseline and 16 weeks later (after the patients completed psychotherapy). HR and HC adolescents were compared at baseline and at completion of the study. We also conducted further analysis by separating into two groups the HR adolescents who responded to psychotherapy (n=17) and those who did not (n=11). At baseline, the HR group had significantly lower performance on verbal memory and processing speed than the HC group. At week 16, HR adolescents performed as well as HC adolescents in all cognitive domains. Among patients, better performance on visual memory was observed in those who responded to psychotherapy compared to those who did not. We concluded that lower performance on verbal memory and processing speed may be associated with a high risk for suicide among adolescents. Improvement in visual memory might be related to a lower risk for suicide in adolescents.

Lack of neural evidence for implicit language learning in 9-month-old infants at high risk for autism.

Word segmentation is a fundamental aspect of language learning, since identification of word boundaries in continuous speech must occur before the acquisition of word meanings can take place. We previously used functional magnetic resonance imaging (fMRI) to show that youth with autism spectrum disorder (ASD) are less sensitive to statistical and speech cues that guide implicit word segmentation. However, little is known about the neural mechanisms underlying this process during infancy and how this may be associated with ASD risk. Here, we examined early neural signatures of language-related learning in 9-month-old infants at high (HR) and low familial risk (LR) for ASD. During natural sleep, infants underwent fMRI while passively listening to three speech streams containing strong statistical and prosodic cues, strong statistical cues only, or minimal statistical cues to word boundaries. Compared to HR infants, LR infants showed greater activity in the left amygdala for the speech stream containing statistical and prosodic cues. While listening to this same speech stream, LR infants also showed more learning-related signal increases in left temporal regions as well as increasing functional connectivity between bilateral primary auditory cortex and right anterior insula. Importantly, learning-related signal increases at 9 months positively correlated with expressive language outcome at 36 months in both groups. In the HR group, greater signal increases were additionally associated with less severe ASD symptomatology at 36 months. These findings suggest that early differences in the neural networks underlying language learning may predict subsequent language development and altered trajectories associated with ASD risk.