Moderate Elevation Research Articles

Cerebrospinal fluid and blood profiles of transfer RNA fragments show age, sex, and Parkinson's disease-related changes.

Transfer RNA fragments (tRFs) have recently been shown to be an important family of small regulatory RNAs with diverse functions. Recent reports have revealed modified tRF blood levels in a number of nervous system conditions including epilepsy, ischemic stroke, and neurodegenerative diseases, but little is known about tRF levels in the cerebrospinal fluid (CSF). To address this issue, we studied age, sex, and Parkinson's disease (PD) effects on the distributions of tRFs in the CSF and blood data of healthy controls and PD patients from the NIH and the Parkinson's Progression Markers Initiative (PPMI) small RNA-seq datasets. We discovered that long tRFs are expressed in higher levels in the CSF than in the blood. Furthermore, the CSF showed a pronounced age-associated decline in the level of tRFs cleaved from the 3'-end and anti-codon loop of the parental tRNA (3'-tRFs, i-tRFs), and more pronounced profile differences than the blood profiles between the sexes. In comparison, we observed moderate age-related elevation of blood 3'-tRF levels. In addition, distinct sets of tRFs in the CSF and in the blood segregated PD patients from controls. Finally, we found enrichment of tRFs predicted to target cholinergic mRNAs (Cholino-tRFs) among mitochondrial-originated tRFs, raising the possibility that the neurodegeneration-related mitochondrial impairment in PD patients may lead to deregulation of their cholinergic tone. Our findings demonstrate that the CSF and blood tRF profiles are distinct and that the CSF tRF profiles are modified in a sex-, age-, and disease-related manner, suggesting that they reflect the inter-individual cerebral differences and calling for incorporating this important subset of small RNA regulators into future studies.

Sigma-1 receptor agonist, (+)-pentazocine, is neuroprotective in a Brown Norway rat microbead model of glaucoma

PurposeGlaucoma is a worldwide leading cause of irreversible blindness. Standard treatments lower intraocular pressure (IOP). Novel treatments to prevent optic nerve (ON) degeneration are needed. Here, we investigate the hypothesis that sigma-1 receptor (S1R) agonist (+)-pentazocine (PTZ) is neuroprotective in a Brown Norway (BN) rat, microbead model of glaucoma. MethodsBN rats (9–11 weeks, male and female) were treated by intraperitoneal injection, 3 times per week with (+)-PTZ (2 mg/kg) or vehicle (VEH) alone. Treatment started 1 week prior to intraocular injection of polystyrene microbeads to elevate IOP. IOP was measured 2–3 times per week. Five weeks post microbead injection, rats were euthanized. ONs were removed, then fixed and processed for 63x oil, light microscope imaging of toluidine blue stained ON cross sections. To facilitate comparison of ON morphology from VEH and (+)-PTZ treated rats with similar ocular hypertensive insults, rats were assigned to low (IOP ≤15.8 mmHg), moderate (15.8 < IOP <28.0 mmHg), and high (IOP ≥28.0 mmHg) groups based on average IOP in the microbead injected eye. Axon numbers, axon density, axonal and glial areas, axon loss, and axon size distributions of naïve, bead, and contralateral ONs were assessed using QuPath program for automated image analysis. Results(+)-PTZ treatment of BN rats protected ONs from damage caused by moderate IOP elevation. Treatment with (+)-PTZ significantly reduced axon loss and glial areas, and increased axon density and axonal areas compared to ONs from VEH treated rats with moderate IOP. (+)-PTZ-mediated neuroprotection was independent of IOP lowering effects. At average IOP ≥28.0 mmHg, (+)-PTZ treatment did not provide measurable neuroprotection. ONs from contralateral eyes exhibited subtle, complex changes in response to conditions in the bead eyes. ConclusionsS1R agonist (+)-PTZ shows promise as a neuroprotective treatment for glaucoma. Future studies to understand the complex molecular mechanisms by which (+)-PTZ provides this neuroprotection are needed.

Prevalence and Severity of Dry Eye Disease Symptoms Among Diabetics: A Nationwide Survey.

Diabetes mellitus (DM) microvascular complications can impair corneal sensitivity and lacrimal gland functioning, leading to dry eye disease (DED). Hence, this study aimed to measure the prevalence and severity of DED symptoms, and the related risk factors, among the Saudi diabetic population. This is a retrospective, cross-sectional, survey-based study which targeted Saudi adults (20 years and older) previously diagnosed with type 1 or type 2 DM. It was conducted in eight primary healthcare centers (PCHs) scattered around eight different provinces of Saudi Arabia (SA). The prevalence and severity of DED were measured by the Ocular Surface Disease Index (OSDI). The total study population was 389 subjects, of which 182 (46.8%) were males and 207 (53.2%) were females. The overall prevalence of DED was 51.7%. Among those, 20.3% of patients had mild dryness, 11.1% had moderate dryness, and 20.3% had severe dryness. Glycosylated hemoglobin (HbA1c) levels of 6.5% or higher proved to be an independent risk factor for the development of DED symptoms, 3.6-folds higher for HbA1c levels of 6.5% to 9% (AOR=3.573; p=0.001), and 2.3-folds higher for HbA1c levels higher than 9% (AOR=2.293; p=0.013). The long duration of diabetes did not show a significant association with manifesting DED symptoms (p=0.263). Half of the diabetic population complained of DED symptoms, compared to one-third of the previously studied general Saudi population. Patients with mild to moderate HbA1c elevation were more likely to report DED symptoms than those with severe elevation, which could be related to impaired corneal sensation. Therefore, a routine ophthalmological examination is recommended.

ODP515 Severe thyrotoxicosis caused by subacute thyroiditis

Abstract Background Subacute thyroiditis, also named giant cell thyroiditis, painful thyroiditis, and de Quervain's thyroiditis, usually presents with neck pain or discomfort, a tender diffuse goiter and mild or moderate elevation of serum free T4 and T3 levels. Here we report a case of subacute thyroiditis patient presenting with severe thyrotoxicosis. Clinical case: A 27-year-old woman with no significant past medical history presents to the emergency room with palpitations and abnormal EKG with heart rate at 160 beats per minute. She developed a sore throat 3 days prior to the presentation, but she did not have neck pain or fever. She reports a 3-month history of hair loss, headaches and weight gain. Labs showed significantly elevated free T4 greater than 7.7 ng/dl (0.8-1.7) and free T3 level at 20.7 pg/ml (2. 0-4.8), and suppressed TSH less than 0. 01 uIU/ml (0.45-4.5) and normal ESR at 15 mm/hour. Her TPO antibody was greater than 1300 u/ml. Thyroid stimulating immunoglobulin (TSI) and TSH receptor antibody (TRab) were obtained but results were pending when she was discharged from the hospital. She has no typical clinical features of subacute thyroiditis with normal ESR and her free T3 and free T4 levels were significantly elevated. She was discharged on Methimazole and Propranolol and to do neck ultrasound as outpatient and follow-up TSI and TRab results and repeat free T4 and T3 in 1 week. Her neck ultrasound revealed mild hypervascularity but no Graves’ features. Her TSI and TRab were negative and free T4 level had no improvement even on significant dose of Methimazole. All the findings argue against Graves’ disease, but support subacute thyroiditis. Then Methimazole was discontinued and Prednisone was started at 20 mg daily and quickly taper to 5 mg daily in 2 weeks then stopped. After on Prednisone for 3 weeks, her free T4 was close to normal at 2. 0 ng/dl, T3 normal at 120 ng/dl, although TSH is suppressed. After stopped Prednisone for 2 weeks, her free T4, T3 and TSH were all back to normal. She is currently euthyroid without any medication at 5 months after her initial presentation. Conclusion Treatment of patients with subacute thyroiditis is pain relief with NSAID or Prednisone when NSAID is not effective. Anti-thyroid medications are rarely effective even in subacute thyroiditis patient with thyroid storm. Our case illustrated the role of corticosteroids in the treatment of subacute thyroiditis patient with severe thyrotoxicosis. Neck ultrasound and thyroid antibodies including TSI and TRab are critical to make a correct diagnosis in subacute thyroiditis patient with severe thyrotoxicosis. Presentation: No date and time listed

17 Heritability Estimate of Heart Score

Abstract Feedlot heart disease (FHD), also known as bovine congestive heart failure, affects feedlot cattle at low to moderate elevations. This disease can cause feedlot death and preliminary research suggests unfavorable influences on performance and carcass quality in those individuals reaching their harvest endpoint. The severity of FHD for an individual animal at harvest can be determined by a heart scoring system that ranges from 1 to 5 corresponding to the increasing degree of heart failure with a score of 1 a normal heart and larger scores indicative of increased malformations. Heart scores (HS) are collected on individual animals at harvest. Previous research indicated that differences exist between sires as to their progeny’s propensity for developing FHD as indicated by HS of 3, 4 and 5. As a result of these sire differences, the objective of this study was to estimate heritability of HS obtained from a group of fattened feedlot cattle. Heart scores, numbers of cattle (Grade 1: 290 ; Grade 2: 728; Grade 3: 340; Grade 4: 64; Grade 5: 0) pedigree, and feedlot pen information were collected from 1,422 individual animals. The pedigree used in the evaluation consisted of the 1,422 individuals and 89 unique sires. No dam information was available on the scored animals. Heritability was estimated using a mixed effect animal model and the statistical software package ASReml 3.0. Fixed effects included scorer, sex, and kill age. Sex was not found to be significant in the model. Individual animal was included as the sole random effect. Scorer (P &amp;lt; 0.05) and kill age (P &amp;lt; 0.1) were found to influence variability in heart score, although kill age was detected as a tendency (P = 0.07). The heritability of HS was estimated to be 0.27 ± 0.10. The genetic variation was 0.15 and the phenotypic variation in the model was 0.40. These results suggest, HS is moderately heritable and has the potential to respond to genetic selection.

HYPERHOMOCYSTEINEMIA POTENTIATING HYPERCOAGULABILITY LEADING TO RARE TRIFECTA OF DVT, PULMONARY EMBOLISM, AND LEFT VENTRICULAR THROMBUS FORMATION

HYPERHOMOCYSTEINEMIA POTENTIATING HYPERCOAGULABILITY LEADING TO RARE TRIFECTA OF DVT, PULMONARY EMBOLISM, AND LEFT VENTRICULAR THROMBUS FORMATION

S3168 Sinusoidal Obstruction Syndrome: A Known and Often Missed Complication of Oxaliplatin Therapy

Introduction: Sinusoidal obstruction syndrome (SOS) is caused by sinusoidal endothelial injury due to hematopoietic cell transplantation, liver irradiation or exposure to chemotherapy such as oxaliplatin and may occur days to weeks following exposure. SOS can be a life-threatening complication and its presentation may include jaundice, volume overload or hepatic failure. We present the case of a 32-year-old male with gastroesophageal adenocarcinoma who underwent oxaliplatin-based chemotherapy and developed SOS. Case Description/Methods: A 32-year-old male with no significant medical history presented with dysphagia and weight loss. Esophagogastroduodenoscopy showed a mass at the gastroesophageal junction. He underwent diagnostic laparoscopy which showed peritoneal metastasis. Tissue biopsy was consistent with stage 4 gastroesophageal junction adenocarcinoma. He was started on 5-fluorouracil (5-FU), oxaliplatin and nivolumab. The patient developed thrombocytopenia and moderate aminotransferase elevation after 6 cycles of chemotherapy. An abdominal ultrasound obtained after 10 of 12 cycles of chemotherapy showed portal hypertension. Subsequent abdominal imaging showed worsening ascites (serum ascites to albumin gradient > 1.1), anasarca and splenomegaly. Transjugular liver biopsy showed elevated portal hepatic venous pressure gradient, focal sinusoidal dilatation and centrizonal ischemic changes suggesting drug induced hepatopathy, and a diagnosis of oxaliplatin induced SOS was made. The patient was not a candidate for defibrotide and was treated conservatively. He continued to have worsening ascites with severe direct hyperbilirubinemia and moderately elevated aminotransferases without biliary obstruction (Figure). Discussion: Oxaliplatin-based chemotherapies are known to cause the potentially life-threatening complication of SOS which is oftentimes missed. Our patient developed signs and symptoms suggestive of SOS by cycle 10 of oxaliplatin therapy. These changes included thrombocytopenia, elevated liver associated enzymes, volume overload and portal hypertension. He went on to complete 12 cycles of oxaliplatin with eventual worsening of his portal hypertension related symptoms and worsening of his hepatic function. This case highlights the importance of having a high index of suspicion for the development of SOS with plans to pursue patient-centered discussions regarding alternative chemotherapeutic regimens, instituting prophylactic therapies and timely SOS screening protocols.Figure 1.: Timeline of events leading up to SOS diagnosis.

S3324 An Unusual Case of Chronic Rejection Following Liver Transplant Due to Autoantibody Formation During Pregnancy

Introduction: We present a unique case of chronic rejection due to HLA-antibody formation during pregnancy. Case Description/Methods: A 51-year-old female with a history of autoimmune hepatitis received a live donor liver transplant (LDLT) with her husband as the donor in January 2008. HLA crossmatch testing was performed prior to transplant with a negative result. Patient was well overall for 8 years following liver transplant. Moderate elevation of liver enzymes during this period lead to liver biopsies consistent with autoimmune hepatitis but no evidence of acute rejection. Patient became pregnant 8 years after LDLT. She developed moderate-chronic elevation of liver enzymes during pregnancy with the most prominent peaks being 731 IU/L alkaline phosphatase (N: 40-140 IU/L), 200 IU/L aspartate aminotransferase (N: < 35 IU/L), and 160 IU/L alanine aminotransferase (N: < 52 IU/L). In December 2016, the patient had a liver biopsy displaying microvesicular steatosis, endotheliitis, and bile duct damage representative of acute cellular rejection. The patient was placed on quadruple immunosuppression therapy: everolimus, tacrolimus, prednisone, and mycophenolate mofetil. HLA antibody testing was performed at that time to check for donor specific antibodies (DSA). DSA was identified against HLA DQ6, suggesting sensitization to her husband’s HLA antigens that occurred during pregnancy/delivery. Despite extensive treatment, chronic rejection of the liver transplant prevailed with bile duct damage progressing to ductopenia. Additional treatments for her condition included intravenous immunoglobulin (IVIG) therapy every 28 days, with photopheresis and plasmapheresis to reduce leukocytes and immunoglobulins attacking the transplanted liver respectively. However, even with multi-modal therapy, the patient’s condition worsened indicated by a rising MELD (model of end-stage liver disease) score and bilirubin concentration to 8 mg/dL. Discussion: We present a unique case of acute (antibody-mediated) rejection progressing to chronic rejection in a LDLT patient following pregnancy due to sensitization to donor HLA DQ6. Consistent post-transplant HLA antibody testing should be a consideration for LDLT patients for early detection and treatment of DSA before memory B-cell production allows rejection to become chronic. Testing is especially important for monitoring female patients with LDLTs from spouse due to risk of blood exposure during pregnancy.

A tale of two populations: vital rates of fishers in British Columbia, Canada

AbstractFishers (Pekania pennanti) are a forest‐dependent carnivore of conservation concern in British Columbia, Canada. Ecological, spatial, and genetic evidence suggests that there are 2 distinct populations (Boreal and Columbian) that occur in forests at low to moderate elevations in the boreal and central interior regions of the province. In British Columbia, fishers occur at low densities relative to other parts of their range in North America, are trapped for their fur, and are sensitive to habitat change. Despite these factors, little demographic information exists to assist with management decisions for these populations. We collated and analyzed survival and reproductive data from 100 radio‐tagged fishers from 5 independent studies conducted between 1990 and 2012 in British Columbia: 2 in the Boreal population, and 3 in the Columbian population. We also collated litter size data from 1 den box study and a translocation project of fishers from the Columbian population. Annual survival rates were not significantly different between the populations or between males and females; however, adult survival rates were higher than subadults (0.79 and 0.63, respectively). Subadult females had significantly lower survival rates than other sex or age classes. Reproductive rates were significantly different between the 2 populations (denning rate = 0.54 [Columbian], 0.82 [Boreal]; litter size = 1.7 [Columbian], 2.6 [Boreal]). These differences resulted in net reproductive rates in the Columbian population that were less than half of those in the Boreal population (0.92 kits/reproductive season compared to 2.13, respectively). Population growth rates suggest that the Columbian population may have been declining during the studies, whereas the Boreal population may have been increasing (0.96 compared to 1.20). Consequently, we suggest that focused and intensive habitat and population management for fishers are needed in British Columbia to ensure population sustainability, particularly for the Columbian population.

Determining the Relationship Between Blood Pressure, Kidney Function, and Chronic Kidney Disease: Insights From Genetic Epidemiology.

It is well established that decreased kidney function can increase blood pressure (BP), but it is unproven whether moderately elevated BP causes chronic kidney disease (CKD) or glomerular hyperfiltration. 311 119 White British UK Biobank participants were included in logistic regression analyses to estimate the odds of CKD (defined as long-term kidney replacement therapy, estimated glomerular filtration rate [eGFR]< 60mL/min/1.73m2, or urinary albumin:creatinine ratio ≥3 mg/mmol) associated with higher genetically predicted BP using genetic risk scores comprising 219 systolic and 223 diastolic BP loci. Analyses estimating associations with clinical categories of eGFR and urinary albumin:creatinine ratio were also conducted, with an eGFR ≥120 mL (min·1.73m2) considered evidence of glomerular hyperfiltration. 21 623 participants had CKD: 7781 with reduced eGFR and 15 500 with albuminuria. 1828 participants had an eGFR ≥120 mL/min/1.73m2. Each genetically predicted 10 mmHg higher systolic BP and 5 mmHg higher diastolic BP were associated with a 37% (95% CI, 1.29-1.45) and 19% (1.14-1.25) higher odds of CKD, respectively. Associations were evident for both the reduced eGFR and albuminuria components of the CKD outcome. The odds of hyperfiltration (versus an eGFR ≥60 and <90 mL/min/1.73m2 were 49% higher (95% CI, 1.21-1.84) for each genetically predicted 10 mmHg higher systolic BP. Associations with CKD and hyperfiltration were similar irrespective of preexisting diabetes, vascular disease, or different levels of adiposity. In this general population, genetic epidemiological evidence supports a causal role of life-long differences in BP for decreased kidney function, glomerular hyperfiltration, and albuminuria. Physiological autoregulation may not afford complete renal protection against the moderate BP elevations.

Extraction of quasi-coherent modes based on reflectometry data

The identification of turbulence sources would drive to a deeper understanding of confinement dynamics in tokamak plasmas. Turbulence results from a mixture of instabilities corresponding to sources at different timescales and spatial scales. Using poloidal correlation reflectometry and multi-pin Langmuir probe, it was shown in the T-10 and the Tokamak Experiment for Technology Oriented Research (TEXTOR) tokamaks that the reflectometry frequency spectrum is the superposition of several components: broadband component, quasi-coherent (QC) modes and low-frequency components. The relevance of QC modes is associated with their link with the trapped electron mode instability. This link was exhibited in the transition from the linear ohmic confinement (LOC) to the saturated ohmic confinement (SOC) regime. A method is presented in this paper to extract the QC mode component from the reflectometry data, enabling its separation from the broadband component and the study of its time evolution. It is a first step toward the discrimination of turbulence sources. The central idea explores a way to combine the approach of signal processing and machine learning. The continuous wavelet transform on the basis of complex Morlet wavelet has proved to be efficient in providing a decomposition of a signal at different scales over time for fluctuation tackling; clustering techniques, such as the mini-batch K-means, are able to tackle clusters at different scales. The method was applied to Tore Supra and TEXTOR reflectometry data. In Tore Supra, the amplitude of the extracted QC mode component decreases during the LOC–SOC transition. In TEXTOR, the amplitude of the coherent spectra of the extracted QC mode component is similar to the experimental coherent spectra obtained through correlation reflectometry. The developed method permits the extraction of components, preserving their physical and statistical properties.

Linking maize yields in Veneto Italy, to large-scale atmospheric variability, circulation regimes and weather types

AbstractThis paper describes the relationships between large-scale modes of climate variability and its related weather types with the fluctuations in the yield of maize crops in Veneto, Italy. The teleconnections analysed in this work are the winter North Atlantic Oscillation (NAO) and the summer North Atlantic Oscillation (SNAO); the West African monsoon (WAM) and the Intertropical Front (ITF). Despite that these indices are not rigorously linked to one another, they result in being considerably related to atmospheric circulation regimes and associated weather types. They have an impact on temperature and precipitation patterns in Italy and on yields of maize crops in Veneto, a region located in northeast Italy. Yields are strongly affected by large-scale temperate and tropical variability directly through three main circulation regimes. Troughing weather regimes that produced below average temperatures depress yields over the entire Veneto region, as does the zonal regime that affects rainfall. Results confirm the relevance of large-scale modes and associated weather regimes and types on maize crop yields fluctuations in Veneto.

The Multidimensional Inventory of Dissociation (MID) in Depersonalization Disorder: General Findings with a Clinical Emphasis on Memory and Identity Disturbances

ABSTRACT The Multidimensional Inventory of Dissociation (MID) was administered to 23 participants diagnosed with DSM-IV-TR Depersonalization Disorder (DDD) by structured interview. The MID has not been previously examined in DDD and does not generate a diagnostic formula for the disorder. Mean MID score for the sample was modestly elevated at 18.54, and was significantly correlated with Dissociative Experiences Scale, Cambridge Depersonalization Scale, and Childhood Trauma Questionnaire scores. Criterion A (General Dissociation) Depersonalization and Depersonalization scale scores were markedly elevated (41.70 and 40.98 respectively), followed by moderate elevations in the Identity Confusion (36.01), Trance (25.44), and Memory Problems (23.30) scales. Criterion B (Intrusions from partly dissociated self-states) mean score was modestly elevated (19.13) and declined to 13.67 once items overlapping with the Depersonalization and Identity Confusion scales were excluded. Criterion C (fully dissociated manifestations of other self-states) mean score was minimally elevated (6.57). Of the 168 pathological dissociation items, 55 were clinically elevated in DDD. Closer examination of the Intrusions and Amnesia items that were modestly elevated in DDD revealed that these items did not reflect the presence of alters, but rather represented known depersonalization-related phenomena. We propose a preliminary formula, based on cutoff scores for Criterion A Depersonalization and/or Derealization, Criterion B, and Criterion C (≥20, ≤28, ≤11) for the sensitive diagnosis of DDD (82.6% of participants), which would require future investigation for replication and determination of specificity vis-à-vis the other dissociative disorders.

Against Therapeutic Anticoagulation in Critically Ill COVID-19 Patients.

There were initially three clear lines of evidence in support of an association between thrombosis and coronavirus disease 2019 (COVID-19), as caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection. First, there was evidence of significant coagulation marker changes in some patients affected by COVID-19, primarily a moderate elevation in D-dimer, increase in fibrinogen levels, mildly prolonged prothrombin time, and some derangements in platelet counts.[1] Second, autopsy studies of patients that suffered fatal COVID-19 showed microthrombi in the lungs, thus demonstrating that the virus leads to a pulmonary coagulopathy, which may become systemic as the disease progresses.[2] Third, there were observational studies showing that there were higher rates of thrombotic complications in these patients, despite thromboprophylaxis.

Hydrologic utility of satellite precipitation products in flood prediction: A meta-data analysis and lessons learnt

• A meta-analysis on performance of satellite products was carried out. • The performance of SPP varies under different climate zones. • SPPs that use microwave algorithms were found to outperform the others. • Best performance was found after bias correction and model recalibration. This work summarizes lessons learnt on using satellite precipitation products (SPPs) for flood simulation and prediction and proposes ways forward in this field of research. A meta-analysis was carried out to review: effect of climate zone, topographical features, selection of hydrological models, and calibration procedures on SPPs forced hydrological model performance. SPPs performance was shown to be higher in temperate and tropical than in dry climates. Low lying and moderate elevations areas exhibited high-performance accuracy compared to higher latitudes landscapes. SPPs that use microwave algorithms were found to outperform the others. The best simulation and prediction results were found after bias correction and model recalibration. From a general standpoint, SPPs offer great potential for flood simulation and prediction, but the performance of SPPs needs to be enhanced for operational purposes. The present study discusses bias correction techniques, model recalibration, the importance of interaction between different types of SPPs and hydrological models, and other lessons learned and future directions of using SPPs for future flood applications.

230. The preoperative inflammatory state is an independent risk factor for short term postoperative complications in adult spinal deformity patients

<h3>BACKGROUND CONTEXT</h3> Preoperative risk stratification is critical to determining which adult spinal deformity (ASD) patients may develop postop complications and to maximize surgical success. Currently it is unknown if a preoperative inflammatory state results in a higher risk for postop complications. This information can be used in risk stratification models to aid in complication avoidance. <h3>PURPOSE</h3> To determine if patients with preoperative elevated serum markers for inflammation have higher rates of postoperative complications <h3>STUDY DESIGN/SETTING</h3> Retrospective review of multicenter prospective ASD database. <h3>PATIENT SAMPLE</h3> ASD patients. <h3>OUTCOME MEASURES</h3> C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR), complications by type and by severity of intervention: none, mild, moderate and severe. Demographic and surgical variables: age, estimated blood loss (EBL), operating room (OR) time, body mass index (BMI), America Society of Anesthesia physical classification scale (ASA), Charlson comorbidity index (CCI), Edmonton frailty scale (EF), 3-column osteotomy (3CO), number of post fusion levels. <h3>METHODS</h3> Preoperative labs were drawn on ASD patients and the inflammatory markers were CRP and ESR. CRP thresholds for cardiac risk: normal = 3. The CRP moderate and elevated values were combined into one group named elevated. Normal ESR thresholds: Male age 50, =20, Female >50, =30. Patients were stratified by having normal or elevated markers and rates of complications were compared between the groups. A multivariate model with CRP/ESR and demographic/surgical variables for postoperative complications. Health-related quality of life (HRQOL) metrics were compared <h3>RESULTS</h3> The total number of patients with preoperative CRP was 159 and ESR was 158. CRP: normal=114 patients (71.7%), moderate elevation=28 (17.6%), severe elevation=17 (10.7%). Combined elevated=45/159(28.3%). Elevated ESR=25(15.8%), normal=133(84.2%). The elevated CRP group had significantly higher rate of moderate complication 13/45(28.9%) vs 16/114(14.0%), p=0.03 and severe complication 15/45 (33.3%) vs 17/114(14.9%, p=0.009. Elevated ESR patients had significantly higher rate of moderate complication 9/25 (36.0%) vs 20/133 (15.0%), p=0.01. In multivariable logistic regression elevated CRP had odds ratio for moderate complication of 3.3 (95% CI 1.4-7.6, p=0.006), and for severe complication of 2.3 (95% CI 1.05-5.1, p=0.037). Multivariable logistic regression for elevated ESR and moderate complication had odds ratio of 2.9 (95%CI 1.04-7.8, p=0.041). Elevated CRP also had significantly higher rate of wound complications (15.6% vs 3.5%, p=0.007) and MSK complications (11.1% vs 1.8%, p=0.01). Elevated ESR had significantly higher rate of cardiac complications (32.0% vs 13.5%, p=0.02) and neurological complications (24.0% vs 9.0%, p=0.03). Elevated CRP had worse preoperative leg pain, SRS Activity and VR12 PCS(p<0.05). Elevated ESR had worse baseline ODI (p=0.03). <h3>CONCLUSIONS</h3> A preoperative inflammatory state as defined by elevated CRP and ESR is an independent risk factor for the development of moderate and severe postop complications. Having elevated preop CRP is 3.3 and 2.3 times more likely to have a moderate and severe complication, respectively. Elevated ESR is 2.9 times more likely to have a moderate complication. This data can be used in risk stratification models to aid in minimizing postoperative complications. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

A-300 Differences in MMPI-2 scores for Individuals with and without Acquired Brain Injuries

Abstract Objective: To compare personality features as measured by the MMPI-2 for individuals with and without acquired brain injuries. Methods: Participants were selected from a de-identified clinical database. Thirty-seven (Mage=41.07, Medu=13.05, 59.5% white, and 61.9% male) individuals were identified as having an acquired brain injury and 377 (Mage=32.69, Medu=13.71, 50.2% white, and 56.7% female) did not but had other diagnosis. Significant differences between groups existed for age, education, and gender. An ANCOVA was utilized to test the difference in endorsement of symptoms between individual with and without acquired brain injuries controlling for the significant covariates. Results: Of the ten clinical scales on the MMPI-2, only hypomania (Scale 9) was significantly different between the two groups F(1,412)=7.074, p=.008 with the group with the acquired brain injuries endorsing more hypomanic symptoms than the non-acquired brain injury group. Conclusions: The non-acquired brain injury group fell within the normal range while the individuals in the acquired brain injury group experienced moderate elevation of hypomania. This suggest that individuals in the acquired brain injury group may find themselves experiencing restrictions, agitation, and dissatisfaction on their activity level secondary to the brain injury. Implications for these findings suggest that individuals with acquired brain injuries may benefit from some form of acceptance therapy following the injury as well as continued monitoring of symptoms. Limitation to this study include lack of specificity to the type, timing since incident, and location of the acquired brain injury; limited number of individuals with acquired brain injuries; and lack of diversity within the sample.

Prolactin at moderately increased levels confers a neuroprotective effect in non-secreting pituitary macroadenomas.

Prolactin, a hormone synthesized by the anterior pituitary gland demonstrates promise as a neuroprotective agent, however, its role in humans and in vivo during injury is not fully understood. To investigate whether elevated levels of prolactin attenuate injury to the retinal nerve fiber layer (RNFL) following compression of the optic chiasm in patients with a prolactin secreting pituitary macroadenoma (i.e., prolactinoma). A retrospective cross-sectional study of all pituitary macroadenoma patients treated at a single institution between 2009 and 2019. Primary outcome measures included RNFL thickness, mean deviation, and prolactin levels for both prolactin-secreting and non-secreting pituitary macroadenoma patients. Sixty-six patients met inclusion criteria for this study (14 prolactin-secreting and 52 non-secreting macroadenoma patients). Of 52 non-secreting macroadenoma patients, 12 had moderate elevation of prolactin secondary to stalk effect. Patients with moderate elevation in prolactin demonstrated increased RNFL thickness compared to patients with normal prolactin levels (p < 0.01). Additionally, a significant positive relation between increasing levels of prolactin and RNFL thickness was identified in patients with moderate prolactin elevation (R = 0.51, p-value = 0.035). No significant difference was identified between prolactinoma patients and those with normal prolactin levels. Moderately increased serum prolactin is associated with increased RNFL thickness when compared to controls. These associations are lost when serum prolactin is < 30 ng/ml or elevated in prolactinomas. This suggests a neuroprotective effect of prolactin at moderately increased levels in preserving retinal function during optic chiasm compression.

Spatial distribution and scale-specific controls of soil water-stable aggregates in southeastern China

Soil water-stable aggregates (WSA) are a key indicator of soil stability and are critical for maintaining soil quality and controlling erosion. WSA have spatial heterogeneity and their spatial variability is influenced by different environmental factors at different scales. Few studies, however, have focused on the scale-specific controls of the WSA content on a mountain-plain landform. The objective of this study was to investigate the spatial distribution and scale-specific controls of WSA content using methods of Gaussian geostatistical simulation (GGS) and multivariate empirical mode decomposition (MEMD). A total of 101 soil samples were collected along a sinuous 4200-km transect at a mean interval of 42 km in southeastern China. The WSA content and nine environmental factors, i.e., soil bulk density, clay, silt, sand and organic-matter (SOM) contents, pH, elevation, slope and vegetation coverage (VC) were measured at each sampling site. WSA content was strongly spatially dependent, with a nugget/sill ratio of 7.63%. E-type maps from the GGS with different realizations (10, 25, 50, 100, 200 and 500) had similar spatial patterns, with high WSA content mostly in the south and west of the study area and low WSA content concentrated in the north. The spatial probability map indicated that the locations around Taihu Lake in the north of the study area had a high probability of poor aggregate stability. A multi-scale analysis of influencing factors indicated that intrinsic mode function 1 (IMF1) (23.76%) and IMF2 (23.64%) explained most of the spatial variability of WSA content. The correlations between WSA content and the environmental factors varied with the scale. The dominant controls were soil particle composition at small scale, pH and SOM content at moderate scale and elevation and VC at large scale. The prediction of WSA content at the measurement scale based on the scale-specific controls analyzed with MEMD (R2adj = 0.577) outperformed the prediction of traditional multiple regression (R2adj = 0.356). These results will support accurate practices and management for preventing soil erosion and land degradation.

Assessment of troponin I level in patients with acute myocardial infarction and its impact on clinical outcome

Introduction: Coronary Artery disease is one of the major causes of Mortatlity I the world that included Myocardial ischemia and infarction. Cardiac toponins are (troponin- I and Troponin -T) the markers of myocardial ischemia and they are the sign of Myocardial damage. They can provide important diagnostic and prognostic information. Aim : In the present study the correlation of clinical presentation, complication and outcome with reference of different level (mild, moderate and severe) of elevated troponin enzyme level was studied. Material and method: 100 patientspresented with acute myocardial infarct ion were studied for clinical presentation (hemodynamics, heart failure, mechanical complication, angina, shock) and ICCU stay and total hospital stay, recurrent angina, heart failure, re-infarct, morbidity and mortality was recorded. Their cardiac troponin- I level was measured and corelated accordingly in group 1 (mild elevation: cTnIlevel baseline (0.004) totentimes), group 2 (moderate elevation: cTnIlevel ten times to hundredtimes) and group 3 (severe elevation: cTnIlevel morethan hundredtimes). RESULTS: Significantly greater number of patients with recurrent angina were having severely elevated Troponin-I level. Relocation of patient in ICCU was more with patient with severely elevated level. Severity of cardiac failure and Troponin-I levels were found to be significantly associated with each other.