SD Interval Research Articles

Long-term clinical outcomes of patients with sympathetic ophthalmia

PurposeTo present the long-term clinical outcomes of patients with sympathetic ophthalmia (SO).MethodsRetrospective review of patients’ medical files between 2002 and 2022.ResultsIncluded were seven patients (four males). The mean ± SD age at presentation was 37.9 ± 22.5 years. Four patients had co-morbidities: three had diabetes mellitus type 2 and one had Turner Syndrome. Trauma was the inciting event in six patients and postoperative endophthalmitis in one patient. Decreased visual acuity (VA) was the leading symptom in the sympathizing eye and all of the patients presented with panuveitis. The mean ± SD interval between the triggering incident and the onset of SO in six cases was 4.3 ± 4.2 months. One case presented 30 years following the eye injury. Five patients underwent enucleation/evisceration of the exciting eye. The mean ± SD presenting LogMAR BCVA in the sympathizing eye was 0.57 ± 0.82, and the final LogMAR BCVA was 0.61 ± 0.95. Inflammation was completely controlled in 5 patients at a mean ± SD of 8.55 ± 9.21 months following the institution of immunomodulatory therapy, and it was partially controlled in 2 patients. VA deteriorated in all 3 diabetic patients and improved or remained stable in the 4 young and healthy patients. The mean ± SD follow-up period after achieving drug-free remission was 28 ± 22.8 months. The mean ± SD follow-up time was 6.8 ± 5.6 years.ConclusionsSO is one of the most sight-threatening conditions, affecting the healthy eye. In this cohort, the favorable visual outcome was especially seen in young and healthy individuals. Visual prognosis is directly related to prompt diagnosis and treatment.

Accuracy of Preoperative Ultrasonographic Airway Assessment in Predicting Difficult Laryngoscopies in Adult Patients.

Background and objectives Presently, neck ultrasonography is used as a tool to predict a difficult airway. There are no standardized ultrasonographic criteria that help to predict a difficult airway. This study aims to ultrasonographically assess the anterior neck soft tissue thickness preoperatively based on two parameters-the minimal distance from the hyoid bone to skin (DSHB) and the distance from the skin to the epiglottis midway between the hyoid bone and thyroid cartilage (DSEM)-and find out whether these parameters can predict a difficult airway in adults by correlating with the Cormack-Lehane (CL) grading. Background and objectives After obtaining ethical committee clearance and patient consent, we conducted this study on 96 patients aged between 18 and 60 years, belonging to American Society of Anesthesiologists (ASA) classes one and two, who were admitted for elective surgery under general anesthesia with endotracheal intubation to RL Jalappa Hospital and Research Centre, Tamaka, Kolar, from January 2020 to May 2021. The exclusion criteria were patients with anticipated difficult airway cases, such as obesity, pregnancy, head and neck anatomical pathologies, maxillofacial anomalies, and edentulous patients. The sonography of the airway was first performed preoperatively by an anesthesiologist along with standard clinical tests such as Mallampati (MP) grading. The sonography included two parameters: DSHB and DSEM. The patients were later classified as having easy or difficult laryngoscopy based on USG criteria from the available literature. A DSHB value of greater than 0.66 cm was predicted to be a difficult airway, and less than 0.66 cm was predicted to be easy. A DSEM value greater than 2.03 cm was predicted to be a difficult airway, and less than 2.03 cm was predicted to be easy. After induction of anesthesia, another experienced anesthesiologist performed direct laryngoscopy in the sniffing position with an appropriate-sized Macintosh blade and CL grades. CL grades I and II were considered to be easy laryngoscopies. The quantitative data were presented by mean SD and confidence interval (CI). The qualitative data were presented in percentages, and p-values less than 0.05 were considered statistically significant. To determine the discriminative power of individual tests, the receiver operating characteristic curve and the area under the curve with a 95% confidence interval was noted. Results The two USG parameters DSHB and DSEM may be used to predict difficult laryngoscopy in adult patients, as both have very strong statistical significance. Of the two parameters, DSHB seems to have a better diagnostic value for predicting a difficult airway in our study, as supported by thearea under the curve (AUC) of 97.4% compared to DSEM with an AUC of 88.8%. DSHB has better sensitivity (100%), and DSEM has better specificity (89.77%). Conclusion Our study showed that DSHB and DSEM may aid in predicting difficult laryngoscopies, as a strong statistical significance was present between sonographic measurements and CL grading. DSHB also appeared to have a better diagnostic value for predicting a difficult airway.

Leakage Management after Laparoscopic Sleeve Gastrectomy: A Tertiary Center Experience in Saudi Arabia

Purpose: The goal of this study was to determine the optimal method for treating gastric leaks in terms of resolution rate, complications, admission to the intensive care unit (ICU), conversion to other surgical techniques, and mortality. Methods: A retrospective analysis of patients treated at King Abdul-Aziz Specialist Hospital between 2017 and 2021 for post-LSG leaks. Age, gender, body mass index (BMI), preoperative comorbidities, leak rate, the interval between surgery and leak, the onset and site of leak, as well as the management lines and outcomes, were collected. Results: The leak rate following Laparoscopic Sleeve Gastrectomy (LSG) at our hospital was 0.53 percent, and there were no statistically significant differences in the demographic characteristics of patients with and without leaks. Despite the fact that 87.5 percent of patients were women, this was not statistically significant (P-value:0.09). The mean± SD interval between surgery and leak is 14 ±18.4, with early and acute leaks being the most common. Failure of first-line management, stent migration, and esophageal stricture were the most commoncomplications of leak management in our study. The mean length of hospital stays was 42.4 ±17.1 days, and the mortality rate was 12.5%. Conclusions: Leak after LSG is a drastic complication associated with substantial morbidity and mortality if diagnosis and treatment are delayed. Depending on the patient’s condition, location of the leak, and the time of diagnosis,; leak management may involve conservative, endoscopic, or surgical approaches. There are numerous measures that could be taken to reduce the leak incidence rate. Keywords: Bariatric surgery; Sleeve Gastrectomy; Leak; Treatment; Outcomes

Randomized controlled trial on the effectiveness of silver diamine fluoride in arresting caries in Lagos, Nigeria

Treatment of dental caries in children still remains challenging due to lack of cooperation with conventional treatment modalities. Recently, the use of Silver Diamine Fluoride (SDF) has proved useful in addressing this challenge. Aim: This clinical trial aimed to evaluate the effectiveness of Silver Diamine Fluoride (SDF) in arresting caries in children in Lagos, Nigeria. Methods: This was a phase III balanced randomized controlled school based interventional study on 240 children. The study group was treated with SDF while GIC was used in the control group. Follow up visits in 2 weeks, 1 month, and 3 months were carried out to assess the treatment outcome. Inferential statistics with the use of Pearson Chi-square test and Independent Student t-test were used at 5% level of significance. Results: There was significant relationship between SDF and caries arrest in 2 weeks, 1 month and 3 months’ assessment period (p = 0.001). The control group showed continuous decline (71.7%, 54.3% and 50.9%) in restorative success from 2 weeks to 3 months respectively. The mean ± SD and Confidence Interval (CI) of arrested caries in the SDF group were 113± 1.24 and 113.1 – 113.5 respectively. In the control group the mean ± SD and CI of restorative success were 69.3±11.8 and 67.2 – 71.4. The effect size was 5.24. Conclusion: The result of the study showed that SDF was effective in arresting caries in children without any harm and there was statistically significant difference in the use of 38% SDF in arresting caries in children.

Greater Adherence to Life's Simple 7 Is Associated With Less Arterial Stiffness: the Atherosclerosis Risk in Communities (ARIC) Study.

Greater arterial stiffness is associated independently with increased cardiovascular disease risk. The American Heart Association (AHA) has recommended following "Life's Simple 7 (LS7)" to optimize cardiovascular health; we tested whether better LS7 in middle age is associated with less arterial stiffness in later life. We studied 4,232 black and white participants aged 45-64 years at the baseline (1987-89) visit of the Atherosclerosis Risk in Communities Study cohort who also had arterial stiffness measured in 2011-13 (mean ± SD interval: 23.6 ± 1.0 years). We calculated a 14-point summary score for baseline LS7 and classified participants as having "poor" (0-4), "average" (5-9), or "ideal" (10-14) cardiovascular health. We used logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (95% CI) for arterial stiffening: a high carotid-femoral pulse wave velocity (cfPWV, ≥13.23 m/s) or a high central pulse pressure (central PP, ≥ 82.35 mm Hg). The age, race, sex, and heart rate-adjusted ORs (95% CI) for high cfPWV in the "ideal," "average," and "poor" LS7 summary categories were 1 (Reference), 1.30 (1.11, 1.53), and 1.68 (1.10,2.56), respectively (P-trend = 0.0003). Similarly, the adjusted ORs (95% CI) for high central PP across LS7 summary categories were 1 (Reference), 1.48 (1.27, 1.74), and 1.63 (1.04, 2.56), respectively (P-trend <0.0001). Greater LS7 score in middle age is associated with less arterial stiffness 2-3 decades later. These findings further support the AHA recommendation to follow LS7 for cardiovascular disease prevention.

CT characterisation of feline adrenal glands.

The objectives of this study were to describe the CT characteristics of the adrenal glands in healthy cats, to provide normal reference biometry for adrenal gland size and attenuation values, and to investigate the association with age, sex, laterality and body weight. Retrospective evaluation of 30 CT studies of healthy adult cats recruited from September 2013 to July 2015 was performed. Healthy cats >1 year of age were included based on the absence of clinical signs, unremarkable physical examination, normal results of the complete blood count, biochemical profile, feline immunodeficiency virus, feline leukaemia virus and Bartonella species infection tests. The relationship between gland biometry (size and attenuation values) and the age, sex, laterality and body weight of cats were tested by two-way ANOVA. The intraclass correlation coefficient was assessed and mean, SD, range and reference interval provided. Twenty-seven cats were included. Bilobed, arrowhead and oval adrenal gland shape patterns were recognised, the first being most common. No statistically significant differences were observed between the biometric parameters (length, height and attenuation values) and age, sex, laterality or body weight of the cats. Regarding the width of the adrenal glands, there was a statistically significant effect of sex and laterality. The length (11.6 ± 2.1 mm) and height (6.1 ± 1.3 mm) were the most consistent biometrical parameters to describe adrenal glands. Adrenal gland shape, size and attenuation CT data of healthy feline patients are provided in this study, as well as normal reference intervals for morphometric characterisation based on adrenal length and height.

3D hindfoot alignment measurements based on low-dose biplanar radiographs: a clinical feasibility study

To test a 3D-hindfoot alignment (HA) measurement technique based on low-dose biplanar radiographs (BPRs) in a clinical setting and compare the results with 2D-HA measurements on long axial view radiographs (LARs). This prospective study was approved by the local institutional review board. HA measurements on 3D-BPR and 2D-LAR of 50 patients (29 female; mean age 47 ± 16.6years) were compared (positive values = valgus; negative values = varus). Two independent musculoskeletal radiologists (readers 1 and 2) performed 3D-HA measurements on BPR using a custom-made MATLAB code and measured HA on LAR during two separate readout sessions. Descriptive statistics and intraclass correlation coefficients (ICC) were calculated, and Bland-Altman plots were used for intermethod comparison. Using BPRs, HA was 0.8° ± 9.°1 (range, -20.2 to 20.0) for reader 1, and 0.7° ± 9.5° (range, -21.2 to 18.3) for reader 2. HA on LARs was -2.0 ° ± 7.0° (range, -27.0° to 11.1°) for reader 1 and - 1.7° ± 7.0° (range, -24.1° to 14.3°) for reader 2. Interreader agreement for measurements was excellent, both for BPRs (ICC = 0.992; 95% CI:0.986-0.995) and LAR measurements (ICC = 0.962; 95% CI:0.932-0.978). Mean difference between the two methods was -2.43° (range, -29.4° to 25.6°) for reader 1 and -2.6° (range,-28.7° to 30.2°) for reader 2. On Bland-Altman plots, three measurements of reader 1 and six measurements of reader 2 were outside of the ±1.96 SD interval. Hindfoot alignment measurements on 3D-BPR have an excellent interreader agreement in a clinical setting. Large measurement errors can occur in individual patients using 2D-LAR alone. Therefore, we suggest using 3D-BPR measurements in daily routine for the assessment of HA, which are independent of rotational foot malpositioning.

Relationship of preoperative neurologic score with intervals to regaining micturition and ambulation following surgical treatment of thoracolumbar disk herniation in dogs.

OBJECTIVE To estimate the times required for dogs to regain micturition and ambulation following surgical treatment for thoracolumbar Hansen type I intervertebral disk extrusion (IVDE) and determine whether these variables were associated with preoperative modified Frankel score (MFS). DESIGN Retrospective case series with nested cohort study. ANIMALS 54 dogs weighing < 20 kg (44 lb) that were surgically treated for Hansen type I IVDE at a referral hospital between January and December 2015. PROCEDURES Medical records and CT and MRI data were reviewed. Information was collected regarding dog signalment, type and duration of clinical signs, preoperative MFS, degree of spinal cord compression, type of medical and surgical treatment provided, and intervals from surgery to regaining micturition and ambulation (outcomes). Collected data were evaluated for correlations with outcomes. RESULTS Mean ± SD interval from surgery to regaining micturition was 4.1 ± 4.4 days, and mean interval from surgery to regaining ambulation was 13.8 ± 25.1 days. These intervals differed significantly. Significant negative correlations with MFS were identified for interval to regaining micturition (r = -0.63) and interval to regaining ambulation (r = -0.64). No other correlations with outcome were identified. CONCLUSIONS AND CLINICAL RELEVANCE The amount of time required for dogs to regain micturition and ambulation following surgery for thoracolumbar IVDE was correlated with preoperative severity of clinical signs, as reflected by preoperative MFSs. This information should be useful for pre- and postoperative decision-making and setting of expectations for owners of and clinicians treating affected dogs.

Dexamethasone Intravitreal Implant for Early Treatment and Retreatment of Macular Edema Related to Branch Retinal Vein Occlusion: The Multicenter COBALT Study

Purpose: To evaluate the effect of dexamethasone intravitreal implant for macular edema (ME) following branch retinal vein occlusion (BRVO) in Korean patients. Methods: We performed a prospective, open-label, multicenter study of 71 patients with ME for < 3 months. Retreatment was allowed ≥4 months from the last injection. Results: At 6 and 12 months, mean ± SD best-corrected visual acuity (BCVA) improvement was 18.6 ± 12.9 and 15.3 ± 15.0 letters, respectively. Approximately 70% of maximum treatment response was observed after 1 week. Over the 12-month period, 32 and 49% of patients received 1 and 3 injections, respectively, with a mean ± SD interval of 20.0 ± 5.0 weeks. Patients who required 3 injections had higher central retinal thickness (CRT) and larger macular nonperfusion at baseline compared to those requiring only 1 injection. Adverse events included increased intraocular pressure (35%) and newly diagnosed cataract (16%). Conclusions: Intravitreal dexamethasone treatment with an interval of ≥4 months provides rapid and significantly better improvement in BCVA and CRT in patients with BRVO-associated ME.

Comparison of the everolimus concentrations measured in whole blood with everolimus QMS or sirolimus CMIA

Few years ago, it was proposed that everolimus blood levels could be determined with the commercially available sirolimus chemiluminescence magnetic microparticle immunoassay (CMIA). More recently, a highly specific microsphere system (QMS) has been approved by FDA for therapeutic drug monitoring in humans. Aim of the present study was to compare the results of everolimus assay performed with everolimus QMS and with sirolimus CMIA. The two methods were compared with Passing–Bablok regression and Bland–Altman plot analysis. The Passing–Bablok regression analysis showed that although the results obtained with the two techniques were significantly correlated, CMIA-measured differed from QMS-measured everolimus concentrations by both a systematic and a proportional error. Specifically, at blood levels lower than 5 ng/mL CMIA were lower than QMS-measured everolimus concentrations. On the opposite, at everolimus blood concentrations higher than 10 ng/mL CMIA-estimated values became progressively higher than QMS-measured everolimus concentrations. The analysis of the Bland Altman plot showed a less than optimal agreement of the two tests (5.59% of the data point outside the ±1.96 SD interval). Moreover, the relationship between the difference between EveroQMS and EveroCMIA and their average was clearly concentration dependent with positive and negative values at concentration values lower and higher than 5 ng/mL respectively.In conclusion, our finding showed that the values of everolimus concentrations measured with sirolimus CMIA differ from those detected with the FDA-approved everolimus QMS further suggesting that sirolimus CMIA should not be used anymore for everolimus therapeutic drug monitoring.

Longitudinal decline in speech production in Parkinson's disease spectrum disorders

We examined narrative speech production longitudinally in non-demented (n=15) and mildly demented (n=8) patients with Parkinson's disease spectrum disorder (PDSD), and we related increasing impairment to structural brain changes in specific language and motor regions. Patients provided semi-structured speech samples, describing a standardized picture at two time points (mean±SD interval=38±24months). The recorded speech samples were analyzed for fluency, grammar, and informativeness. PDSD patients with dementia exhibited significant decline in their speech, unrelated to changes in overall cognitive or motor functioning. Regression analysis in a subset of patients with MRI scans (n=11) revealed that impaired language performance at Time 2 was associated with reduced gray matter (GM) volume at Time 1 in regions of interest important for language functioning but not with reduced GM volume in motor brain areas. These results dissociate language and motor systems and highlight the importance of non-motor brain regions for declining language in PDSD.

Use of Rituximab in Systemic Lupus Erythematosus: A Single Center Experience Over 14 Years.

To describe the clinical outcome and safety of rituximab (RTX) treatment in systemic lupus erythematosus (SLE) patients with severe manifestations or whose disease is refractory to standard immunosuppressive therapy, treated at a single center. This was a retrospective analysis of all patients with SLE treated with RTX at 1 center between June 2000 and December 2013. The clinical outcome was assessed by determining British Isles Lupus Assessment Group (BILAG) scores and anti-double-stranded DNA (anti-dsDNA) and C3 levels before and 6 months after RTX treatment. For safety analysis, adverse events and deaths were recorded. Of a total of 115 patients, 93.9% were female, the mean ± SD age at diagnosis was 26.39 ± 11.90 years, and the mean ± SD disease duration at first RTX treatment was 91.96 ± 84.80 months. A BILAG score variation of -11.26 ± 11.38 (P < 0.001) was recorded 6 months after the first RTX treatment; 40% of patients had a complete response and 27% had a partial response; in 36.5% of patients, C3 levels increased more than 25%, and in 33.5% anti-dsDNA levels decreased more than 50%. Depletion of CD19+ cells was achieved in 94.0% of patients. Hypogammaglobulinemia was detected in 14.9% of patients, with significant reduction for IgM (P < 0.001) and IgG (P = 0.001) levels. Severe infections, infusion-related reactions, and hypersensitivity reactions occurred in 7%, 3.5%, and 2.6% of patients, respectively. Of the 115 patients, 62 patients had repeated RTX treatments, with an average number of 1.95 ± 1.17 cycles per patient and a mean ± SD interval between infusions of 21.44 ± 20.11 months. At the end of followup, 11 patients were deceased; 6 had cardiovascular events. RTX treatment was effective in decreasing disease activity, with a low incidence of adverse effects.

Changes in physical activity among adults with diabetes: a longitudinal cohort study of inactive patients with Type 2 diabetes who become physically active.

AimsTo identify the predictors and clinical effects among inactive patients with diabetes who become physically active, in the setting of a large integrated health system.MethodsWe studied adults with Type 2 diabetes with at least two clinic visits between December 2011 and November 2012 who reported being inactive at their first visit. The mean (±sd) interval between their first and last visit was 6.2 (±2.3) months. We analysed self‐reported moderate‐to‐vigorous physical activity data collected using a structured intake form during routine clinical care.ResultsThe study cohort (N = 6853) had a mean age of 60.2 years; 51.4% were women and 53.6% were non‐white. Nearly two‐thirds (62.5%, n = 4280) reported remaining physically inactive, while 16.0% reported achieving the recommended moderate‐to‐vigorous physical activity levels (≥ 150 min/week) by the last visit of the study period. Female gender (odds ratio 0.77, 95% CI 0.67, 0.88), obesity (BMI 30–34.9 kg/m2: odds ratio 0.76, 95% CI 0.60, 0.97; BMI ≥ 35 kg/m2: odds ratio 0.55, 95% CI 0.42, 0.70), chronic kidney disease (odds ratio 0.78, 95% CI 0.65, 0.94) and depression (odds ratio 0.77, 95% CI 0.62, 0.96) were each independently associated with not achieving the recommended moderate‐to‐vigorous physical activity level, while physician referral to lifestyle education was a positive predictor (odds ratio 1.40, 95% CI 1.09, 1.85). Controlling for baseline differences, patients achieving the recommended moderate‐to‐vigorous physical activity target lost 1.0 kg more weight compared with patients remaining inactive (P < 0.001).ConclusionsPatients with diabetes in a real‐world clinical setting lost weight after becoming physically active; however, nearly two‐thirds of patients remained inactive. Novel interventions to address physical inactivity in primary care should address barriers faced by older patients with medically complex disease.

AB0927 Annual golimumab utilization and costs for psoriatic arthritis patients in united states managed care plans

BackgroundGolimumab (GLM) has recommended dosing of 50 mg once monthly for the treatment of psoriatic arthritis (PsA) in the United States (U.S.). GLM U.S. utilization data, published thus far, have...

Retrotransposon Activates Ectopic Ptf1 Expression: A Short Tail

Retrotransposon Activates Ectopic Ptf1 Expression: A Short Tail

Diagnostic Accuracy of Dual-Source 64-Slice Multidetector Computed Tomography in Evaluation of Coronary Artery Bypass Grafts

BackgroundThe aim of this study was to compare the diagnostic accuracy of 64-slice multidetector computed tomography (MDCT) with conventional coronary angiography to detect graft patency and stenosis.MethodsIn this retrospective analysis,...

De Novo aneurysms in long–term follow-up CT-angiography of patients with clipped intracranial aneurysms

Background and Objective: This study was conducted to evaluate the de Novo aneurysm formation in the long-term follow-up of patients with clipped intracranial aneurysms. Methods: A total of 459 patients underwent the clipping of ruptured cerebral aneurysms in our institution during 1997 -2008. Of them, 119 patients were available in good condition and agreed to undergo 64 detector row computed tomography (CT) angiography. In addition, 8 patients with subarachnoid hemorrhage (SAH) underwent CT angiography. Results: The mean ± SD interval from surgery was 7.2±2.3 years for CT-angiography controlled patents. De novo aneurysms were detected in 5 of 119 (4.5%) patients and 4 of 8 patients with new subarachnoid hemorrhage. A history of multiple aneurysms was associated with the de novo aneurysm formation (p< 0.001). Conclusion: The risk of the de novo aneurysm formation in patients with clipped aneurysm is significant in long term follow-up. CT-angiography can be used as a non-invasive method for detection of de novo aneurysms in these patients.

A Cross-Sectional Study of Plasma Risperidone Levels With Risperidone Long-Acting Injectable

While 65%-80% occupancy of dopamine D2 receptors with antipsychotics has been proposed to achieve optimal therapeutic response during acute treatment of schizophrenia, it remains unclear as to whether it is also necessary to maintain D2 receptor occupancy within this "safe" window for ongoing maintenance treatment. The data are especially scarce for long-acting antipsychotic formulations. Clinically stable patients with schizophrenia (DSM-IV) receiving a stable dose of risperidone long-acting injectable (LAI) as antipsychotic monotherapy for at least 3 months and free of any psychiatric hospitalization over the past 6 months were included. Dopamine D2 receptor occupancy levels at trough were estimated from plasma concentrations of risperidone plus 9-hydroxyrisperidone immediately before the intramuscular injection of risperidone LAI, using a 1-site binding model derived from our previous positron emission tomography data. This study was conducted from October to December 2011. 36 patients were included in this study (mean ± SD age, 49.3 ± 14.0 years; mean ± SD dose and interval of injections, 38.2 ± 11.6 mg and 16.5 ± 14.0 days, respectively). Mean ± SD D2 receptor occupancy was 62.1% ± 15.4%; 52.8% of the subjects (n = 19) did not demonstrate an occupancy of ≥ 65%. On the other hand, 13.9% (n = 5) showed a D2 occupancy as high as over 80% at the estimated trough. More than half of patients taking risperidone LAI maintained clinical stability without achieving continuous blockade of dopamine D2 receptors ≥ 65% in real-world clinical settings. Results suggest that sustained dopamine D2 receptor occupancy levels of ≥ 65% may not be necessary for maintenance treatment with risperidone LAI in schizophrenia.

P1‐015: Brain and hippocampal rates of atrophy in familial Alzheimer's disease mutation carriers: Preliminary findings from the DIAN study

The Dominantly Inherited Alzheimer Network (http://dian-info.org/) study is an international clinical, biomarker and multi-modality imaging study of individuals at risk for autosomal dominant Alzheimer's disease and those already mildly affected. This prospective study of these individuals provides an opportunity to follow these individuals through different stages of the disease process, starting several years before symptoms are evident. We report here the first longitudinal analyses of cerebral and hippocampal atrophy rates from the DIAN cohort. All DIAN participants have T1-weighted volumetric MRI scanning at baseline. We analysed data from the first 22 participants with a follow-up MRI scan (mean ± sd interval 12.7 ± 0.9 months). Seventeen subjects were symptomatic mutation carriers (sMut+) with Clinical Dementia Rating (CDR) scores >0 aged 46.4 ± 9.6 years; three were asymptomatic carriers (aMut+) with CDR = 0; and two were non-carriers (NC). The aMut+ and NC were combined into one group for this initial analysis (age: 34.5 ± 5.4 years). The whole brain and hippocampi were first delineated using an automated procedure. Annualized atrophy rates were measured by volumetric difference as well as the Boundary Shift Integral (BSI). Two sample t-tests assuming unequal variances were performed between the annualized atrophy rates of the sMut+ group and the combined NC/aMut+ group. Brain BSI atrophy rates were higher (see Table) in the symptomatic subjects (1.9% vs. 0%/year; P = 0.003). However, the difference in hippocampal atrophy rates was not statistically significant (2.5% vs. 0.5%/year; P = 0.057 for volumetric). Initial analysis of atrophy rates from this cohort indicates that brain atrophy rates are higher in symptomatic mutation carriers than in asymptomatic carriers or non-carriers. The lack of a detectable difference in hippocampal atrophy rates may reflect the small sample size and that these preliminary analyses included presymptomatic mutation carriers in the control group who may have already had increasing rates of hippocampal atrophy. Over 200 subjects will be followed longitudinally, so as more data are acquired, we will separately analyze atrophy rates in asymptomatic carriers and non-mutation carriers, estimate sample sizes for trials and assess the relationship between atrophy rates and symptom onset.

The reproductive performance of Thoroughbred mares treated with intravaginal progesterone at the start of the breeding season

The objective of this study was to investigate the effects of intravaginal progesterone on the reproductive performance of transitional Thoroughbred mares on commercial stud farms. Two hundred twenty-seven (227) non-lactating transitional Thoroughbred mares aged between 4 and 18 y (mean 9.4 ± 3.2 y) located on three stud farms in the Waikato region of New Zealand were used in the study performed during four consecutive breeding seasons (2007–10). Mares were age-matched in pairs and either treated with an intravaginal progesterone releasing device (Cue-Mare, 1.72 g progesterone, 10% w/w) for up to 10 d (Treated; n = 126) or left untreated (Control; n = 101). In both groups, 1,667 iu of hCG was given IV when an ovarian follicle ≥35 mm was detected (in conjunction with estrous behavior) and each mare was bred by natural service. Treated mares were served earlier in the breeding season (mean ± SD interval to first service was 13.9 ± 3.0 vs 26.7 ± 13.2 d for Treated and Control groups, respectively; P < 0.001). In the Treated and Control groups, 95.2 and 42.6% of mares were served within the first 21 d of the season (P < 0.001). Treated mares conceived earlier in the breeding season (mean number of days to conception 37.5 ± 14.2 vs 50.8 ± 21.3 d, P = 0.01). There was no difference between groups in the first service pregnancy rates (53.9 and 50.5% for Treated and Control mares, P = 0.89). Treatment with an intravaginal device increased the number of mares conceiving by the end of the breeding season (91.3 vs 82.3% for Treated and Control groups, P = 0.04). Therefore, this treatment protocol appeared to offer a convenient, economical and reliable method for managing transitional mares on commercial Thoroughbred stud farms.