Synergistic negative effects between a fungicide and high temperatures on homing behaviours in honeybees

Interactions between environmental stressors may contribute to ongoing pollinator declines, but have not been extensively studied. Here, we examined the interaction between the agricultural fungicide Pristine (active ingredients: 25.2% boscalid, 12.8% pyraclostrobin) and high temperatures on critical honeybee behaviours. We have previously shown that consumption of field-realistic levels of this fungicide shortens worker lifespan in the field and impairs associative learning performance in a laboratory-based assay. We hypothesized that Pristine would also impair homing and foraging behaviours in the field, and that an interaction with hot weather would exacerbate this effect. Both field-relevant Pristine exposure and higher air temperatures reduced the probability of successful return on their own. Together, the two factors synergistically reduced the probability of return and increased the time required for bees to return to the hive. Pristine did not affect the masses of pollen or volumes of nectar or water brought back to the hive by foragers, and it did not affect the ratio of forager types in a colony. However, Pristine-fed bees brought more concentrated nectar back to the hive. As both agrochemical usage and heat waves increase, additive and synergistic negative effects may pose major threats to pollinators and sustainable agriculture.

Seasonal variability in physiology and behavior affect the impact of fungicide exposure on honey bee (Apis mellifera) health

Honey bee pollination services are of tremendous agricultural and economic importance. Despite this, honey bees and other pollinators face ongoing perils, including population declines due to a variety of environmental stressors. Fungicides may be particularly insidious stressors for pollinators due to their environmental ubiquity and widespread approval for application during crop bloom. The mechanisms by which fungicides affect honey bees are poorly understood and any seasonal variations in their impact are unknown. Here we assess the effects on honey bee colonies of four-week exposure (the approximate duration of the almond pollination season) of a fungicide, Pristine® (25.2% boscalid, 12.8% pyraclostrobin), that has been commonly used for almonds. We exposed colonies to Pristine® in pollen patties placed into the hive, in either summer or fall, and assessed colony brood and worker populations, colony pollen collection and consumption, and worker age of first foraging and longevity. During the summer, Pristine® exposure induced precocious foraging, and reduced worker longevity resulting in smaller colonies. During the fall, Pristine® exposure induced precocious foraging but otherwise had no significant measured effects. During the fall, adult and brood population levels, and pollen consumption and collection, were all much lower, likely due to preparations for winter. Fungicides and other pesticides may often have reduced effects on honey bees during seasons of suppressed colony growth due to bees consuming less pollen and pesticide.

Comparison of Inguinal Herniotomies with and Without Opening the External Oblique Aponeurosis in Children Above the Age of Two

Background

Mitchell-Banks technique (MBT), in which inguinal canal is not opened, usually used in inguinal hernia repair in children under 2 years of age. The majority of pediatric surgeons tend to open the inguinal canal while performing inguinal hernia surgery in children over 2 years of age, called as modified Ferguson herniotomy (FH).

Aims

This study aimed to compare early and late complications of the MBT and FH in over 2 years of age patients who underwent inguinal hernia surgery.

Patients and Methods

We retrospectively reviewed the medical records of all children between 2 and 16 years old who underwent inguinal herniotomy procedure using the MBT and FH between January 2013 and December 2019. Patients were evaluated in terms of demographic data, early and late complications.

Results

This study included 834 children. Of these, 379 (44.8%) were operated on by an FH with opening the inguinal canal (Group 1), and 455 (55.2%) by MBT superficially to the external ring (Group 2). There were 68 (17.9%) females and 311 (82.1%) males in group 1, while there were 151 (33.2%) females and 304 (66.8%) males in group 2. Early complications were wound infection (1.1% in the group 1 vs. 1.3% in the group 2, P = 1.00) and scrotal hematoma (1.3% vs. 1.8%, P = 0.89). Late complications included recurrence (1.6% in the group 1 vs. 1.8% in the group 2, P = 0.12), undescended testis (2.1% vs. 0.7%, P = 0.71), testicular atrophy (1.5% vs. 0.4%, P = 0.79), and hydrocele (1.9% vs. 1.8%, P = 0.87). There was no statistically significant difference in terms of early and late complications ratio between two groups.

Conclusion

This study showed that inguinal hernia repair performed without opening the inguinal canal in children older than 2 years do not lead to an increase in complications. In this respect, MBT can be used as a simple and safe procedure in older children.

The active ingredients of a mitotoxic fungicide negatively affect pollen consumption and worker survival in laboratory-reared honey bees (Apis mellifera)

Recent observations of many sublethal effects of pesticides on pollinators have raised questions about whether standard short-term laboratory tests of pesticide effects on survival are sufficient for pollinator protection. The fungicide Pristine® and its active ingredients (25.2% boscalid, 12.8% pyraclostrobin) have been reported to have low acute toxicity to caged honey bee workers, but many sublethal effects at field-relevant doses have been reported and Pristine® was recently found to increase worker pollen consumption, reduce worker longevity and colony populations at field relevant concentrations (Fisher et al. 2021). To directly compare these whole-colony field results to more standard laboratory toxicology tests, the effects of Pristine®, at a range of field-relevant concentrations, were assessed on the survival and pollen consumption of honey bee workers 0-14 days of age. Also, to separate the effects of the inert and two active ingredients, bees were fed pollen containing boscalid, pyraclostrobin, or pyraclostrobin plus boscalid, at concentrations matching those in the Pristine® treatments. Pyraclostrobin significantly reduced pollen consumption across the duration of the experiment, and dose-dependently reduced pollen consumption on days 12-14. Pristine® and boscalid significantly reduced pollen feeding rate on days 12-14. Boscalid reduced survival in a dose-dependent manner. Consumption of Pristine® or pyraclostrobin plus boscalid did not affect survival, providing evidence against strong negative effects of the inert ingredients in Pristine® and against negative synergistic effects of boscalid and pyraclostrobin. The stronger toxic effects of Pristine® observed in field colonies compared to this laboratory test, and the opposite responses of pollen consumption in the laboratory and field to Pristine®, show that standard laboratory toxicology tests can fail to predict responses of pollinators to pesticides and to provide protection.

A common fungicide, Pristine®, impairs olfactory associative learning performance in honey bees (Apis mellifera)

Although fungicides were previously considered to be safe for important agricultural pollinators such as honey bees, recent evidence has shown that they can cause a number of behavioral and physiological sublethal effects. Here, we focus on the fungicide Pristine® (active ingredients: 25.2% boscalid, 12.8% pyraclostrobin), which is sprayed during the blooming period on a variety of crops and is known to affect honey bee mitochondria at field-relevant levels. To date, no study has tested the effects of a field-relevant concentration of a fungicide on associative learning ability in honey bees. We tested whether chronic, colony-level exposure at field-relevant and higher concentrations of Pristine® impairs performance on the proboscis extension reflex (PER) paradigm, an associative learning task. Learning performance was reduced at higher field-relevant concentrations of Pristine®. The reductions in learning performance could not be explained by effects on hunger or motivation, as sucrose responsiveness was not affected by Pristine® exposure. To determine whether Pristine®'s negative effects on learning performance were mediated at a specific life stage, we conducted a cross-fostering experiment that exposed bees to the fungicide either only as larvae, only as adults, or during both stages. We found that exposure across the entire life was necessary to significantly reduce learning performance, although non-significant reductions occurred when bees were exposed during just one stage. Our study provides strong evidence that Pristine® has significant sublethal effects on learning performance. As associative learning is a necessary ability for foraging, our results raise concerns that Pristine® could impair foraging abilities and substantially weaken colony health.

Heritable Cognitive Phenotypes Influence Appetitive Learning but not Extinction in Honey Bees

Learning and attention allow animals to better navigate complex environments. While foraging, honey bees (Apis mellifera L.) learn several aspects of their foraging environment, such as color and odor of flowers, which likely begins to happen before they evaluate the quality of the food. If bees begin to evaluate quality before they taste food, and then learn the food is depleted, this may create a conflict in what the bee learns and remembers. Individual honey bees differ in their sensitivity to information, thus creating variation in how they learn or do not learn certain environmental stimuli. For example, foraging honey bees exhibit differences in latent inhibition (LI), a learning process through which regular encounter with a stimulus without a consequence such as food can later reduce conditioning to that stimulus. Here, we test whether bees from distinct selected LI genotypes learn differently if reinforced via just antennae or via both antennae + proboscis. We also evaluate whether learned information goes extinct at different rates in these distinct LI genetic lines. We find that high LI bees learned significantly better when they were reinforced both antenna + proboscis, while low LI and control bees learned similarly with the two reinforcement pathways. We also find no differences in the acquisition and extinction of learned information in high LI and low LI bees. Our work provides insight into how underlying cognition may influence how honey bees learn and value information, which may lead to differences in how individuals and colonies make foraging decisions.

Field cross-fostering and in vitro rearing demonstrate negative effects of both larval and adult exposure to a widely used fungicide in honey bees (Apis mellifera)

Pollinators and other insects are experiencing an ongoing worldwide decline. While various environmental stressors have been implicated, including pesticide exposure, the causes of these declines are complex and highly debated. Fungicides may constitute a particularly prevalent threat to pollinator health due to their application on many crops during bloom, and because pollinators such as bees may consume fungicide-tainted pollen or nectar. In a previous study, consumption of pollen containing the fungicide Pristine® at field-relevant concentrations by honey bee colonies increased pollen foraging, caused earlier foraging, lowered worker survival, and reduced colony population size. Because most pollen is consumed by young adults, we hypothesized that Pristine® (25.2% boscalid, 12.8% pyraclostrobin) in pollen exerts its negative effects on honey bee colonies primarily on the adult stage. To rigorously test this hypothesis, we used a cross-fostering experimental design, with bees reared in colonies provided Pristine® incorporated into pollen patties at a supra-field concentration (230 mg/kg), only in the larvae, only in the adult, or both stages. In contrast to our predictions, exposure to Pristine® in either the larval or adult stage reduced survival relative to control bees not exposed to Pristine®, and exposure to the fungicide at both larval and adult stages further reduced survival. Adult exposure caused precocious foraging, while larval exposure increased the tendency to forage for pollen. These results demonstrate that pollen containing Pristine® can induce significant negative effects on both larvae and adults in a hive, though the magnitude of such effects may be smaller at field-realistic doses. To further test the potential negative effects of direct consumption of Pristine® on larvae, we reared them in vitro on food containing Pristine® at a range of concentrations. Consumption of Pristine® reduced survival rates of larvae at all concentrations tested. Larval and adult weights were only reduced at a supra-field concentration. We conclude that consumption of pollen containing Pristine® by field honey bee colonies likely exerts impacts on colony population size and foraging behavior by affecting both larvae and adults.

Can we estimate cytokine storm from initial computed tomography images of Coronavirus disease-2019 patients?

OBJECTIVES

The present study aims to investigate whether elementary lesions detected at the time of the diagnosis, their distribution characteristics, and CT scoring can be predictive of a cytokine storm.

BACKGROUND

CT might have a prognostic predictive value beyond its diagnostic value.

METHODS

Sixty-eight patients, 32 with cytokine storm and 36 without cytokine storm, were included in the study. Four different scoring methods were created according to elementary lesions, distribution and involvement rate. CT scores and demographic findings of the cases were compared in the cytokine storm and non-cytokine storm groups.

RESULTS

The mean age of patients was 57.72 (SD: 13.5) and 40 (58.8 %) of them were male. The cytokine storm was significantly more common among male patients and patients of older age (p=0.04).  The AUC values of CT score 1, CT score 2, CT score 3, and CT score 4 were as follows; 0.772 (95% CI; 0.651-0.892), 0.766 (95% CI; 0.647-0.885), 0.758 (95% CI; 0.639-8.78), and 0.760 (95% CI; 0.640-0.881), respectively. All CT scores had better predictive values in males.

CONCLUSIONS

CT scoring at the time of admission can be used to predict cases that may develop cytokine storm later (Tab. 4, Fig. 2, Ref. 15).

Consumption of field-realistic doses of a widely used mito-toxic fungicide reduces thorax mass but does not negatively impact flight capacities of the honey bee (Apis mellifera)

Commercial beekeepers in many locations are experiencing increased annual colony losses of honey bees (Apis mellifera), but the causes, including the role of agrochemicals in colony losses, remain unclear. In this study, we investigated the effects of chronic consumption of pollen containing a widely-used fungicide (Pristine®), known to inhibit bee mitochondria in vitro, which has recently been shown to reduce honey bee worker lifespan when field-colonies are provided with pollen containing field-realistic levels of Pristine®. We fed field colonies pollen with a field-realistic concentration of Pristine® (2.3 ppm) and a concentration two orders of magnitude higher (230 ppm). To challenge flight behavior and elicit near-maximal metabolic rate, we measured flight quality and metabolic rates of bees in two lower-than-normal air densities. Chronic consumption of 230 but not 2.3 ppm Pristine® reduced maximal flight performance and metabolic rates, suggesting that the observed decrease in lifespans of workers reared on field-realistic doses of Pristine®-laced pollen is not due to inhibition of flight muscle mitochondria. However, consumption of either the 230 or 2.3 ppm dose reduced thorax mass (but not body mass), providing the first evidence of morphological effects of Pristine®, and supporting the hypothesis that Pristine® reduces forager longevity by negatively impacting digestive or nutritional processes.

One-year outcome of transcatheter repair of tricuspid regurgitation: comparison edge-to-edge repair versus anuloplasty

 

Tricuspid regurgitation (TR) is found to be associated with increased mortality, morbidity, and impaired quality of life. The interventional tricuspid valve repair techniques are being increasingly performed. We aimed to compare the mid-term outcomes of both methods (Clipping and Banding) in our patient cohort. F

We retrospectively included 60 patients who underwent between January 2016 to March 2018 the transcatheter tricuspid valve edge-to-edge repair or annuloplasty in our center. Follow up (FU) examinations were done 12.6±7.6 months. Comprehensive transthoracic echocardiography inclusively 3D acquisitions were performed before and at FU in all patients. The 3D data were used for strain analysis of left and right ventricles and atriums through a dedicated automated offline program (TomTec).

We retrospectively included 60 patients (75±6.1 years, 40% female) with symptomatic (65% ascites, 95% edema, 100% NYHA>II, 75% liver congestion) severe TR (TR>II, 90% functional) at surgical high risk (EuroSCORE II: 5.2±3.2%). Forty patients underwent transcatheter TV edge-to-edge repair (TTVR, MitraClip, PASCAL), and twenty patients were treated by interventional annuloplasty (Cardioband).

At baseline, the patients underwent edge-to-edge (E2E) repair showed more comorbidities with higher EuroScore II and more decreased functional capacity. Echocardiographical, patients who underwent annuloplasty, presented a more significant coaptation gap with more impaired RV function and more dilated right atrium. In contrast, the E2E group showed to have higher right ventricular systolic pressure. Left ventricular dimensions and functions were comparable between the groups.

Left atrial volume and right atrial pressure were found to be statistically significantly reduced in both groups at FU. RV and RA fractional area change were found to be relevantly improved solely after interventional annuloplasty at FU. Left ventricular end-diastolic pressure significantly increased in the E2E group with relevant reduction of outflow/inflow ratio. Moreover, interventional annuloplasty, as expected, reduces SL diameter more significantly.

Patients showed lower symptoms and better functional capacity 12 months after interventional E2E therapy. Of note, improvement in walking distance was found to be significantly higher in patients who underwent annuloplasty. However, patients were hospitalized significantly more frequently after interventional annuloplasty.

In conclusion, both interventional techniques are safe, feasible, and effective for treatment of tricuspid regurgitation in patients at surgical high risk. Interventional annuloplasty significantly impacts on RV function and geometry, and reduces SL diameter significantly. Patients were found to have decreased symptoms, better functional capacity, as well as fewer rehospitalization 12 months after interventional E2E therapy, although they showed more comorbidities at baseline compared to interventional annuloplasty.

Funding Acknowledgement

Type of funding source: None

The prevalence and determinants of complementary medicine use for nigerian children in the Turkish Republic of Northern Cyprus

Background

Complementary and alternative medicine (CAM) is extensively used in the pediatric population. Environments and the nature of diseases have an impact on the type of CAM therapies used in children.

Aims

This study aims to determine the prevalence and determinants of CAM use among Nigerian children living in the Turkish Republic of Northern Cyprus (TRNC).

Subjects and Methods

A quantitative, descriptive and cross-sectional study was conducted among 50 parents living in the TRNC. The parents were selected by the snowball sampling technique. Data were collected using a self-administered, NAFKAM International-CAM-Questionnaire (I-CAM-Q). The data were analyzed using SPSS version 20. Chi-square test was used to analyze the associations of CAM use with values of P < 0.05 considered statistically significant.

Results

The mean ages of the parents and children were 30 ± 5.56 years and 3 ± 2.17 years, respectively. It was discovered that 34 (68%) out of 50 children had used CAM in the previous 12 months. The most commonly used CAM products were vitamins/minerals (82.4%) and herbs/herbal products (55.9%). While praying for health (61.8%) and relaxation techniques (50.0%) were the most used CAM practices. A majority of the parents perceived that CAM use was beneficial (85.3%). Approximately 10% of the children were prescribed CAM recommendation/treatment by physicians. The most used sources of information were relatives (36%) and friends (14.7%). Parents (58%) indicated that they did not disclose their use of CAMs for their children to a physician/nurse.

Conclusions

CAM is used prevalently in this population and the use of CAM is primarily focused on improving well-being. CAM usage for children increases with parental use. Further qualitative research is needed to understand the parental belief in the use of CAMs for children.

Clinical Performance of a Glass Hybrid Restorative in Extended Size Class II Cavities

Objective:

To evaluate the clinical performance of a glass hybrid restorative compared with a resin composite in the restoration of large and deep Class II cavities after 24 months.

Methods and Materials:

A total of 108 extended size, with the width of the proximal box not interfering with the peak of the cusps and the proximal box in occlusion, Class II lesions in 37 patients were either restored with a glass hybrid restorative or with a micro-hybrid composite resin in combination with selective etching by two experienced operators according to the manufacturer's instructions. Two independent examiners evaluated the restorations at baseline and at the six-, 12-, 18-, and 24-month recalls according to the modified US Public Health Service criteria. Negative replicas at each recall were observed under scanning electron microscopy (SEM) to examine surface characteristics. Data were analyzed statistically.

Results:

After 24 months, 90 restorations were evaluated in 32 patients (recall rate: 86.5%). Four glass hybrid restorations were missing; three were due to bulk and one was due to proximal fracture at 12 months. Only six restorations were scored as bravo at baseline and at the six-, 12-, 18-, and 24-month recalls for color (p&lt;0.05). No significant differences were observed between the two restorative materials for the other criteria evaluated (p&gt;0.05). SEM observations exhibited acceptable surface and marginal adaptation characteristics for both restorative materials at 24 months.

Conclusions:

Although glass hybrid restorations showed significant mismatch in color, both restorative materials exhibited successful performance for the restoration of large Class II cavities after 24 months.

42 Comparison of different imaging modalities for the quantification of tricuspid valve geometry and regurgitation

Objectives

Tricuspid regurgitation (TR) is a frequent valvular heart disease with relevant adverse impact on patients´ prognosis. Imaging of tricuspid valve and tricuspid Regurgitation is through anatomical circumstances is challenging. In this study, we aimed to compare the ability of different imaging modalities to visualize and quantify tricuspid valve (TV) function and annular dimensions.

Methods and Results

We prospectively included 40 consecutive patients (Age: 77.5 ± 7.1 years) with high surgical risk (EuroSCORE II: 8.8 ± 12.1%) and significant TR, who underwent transesophageal echocardiography (TEE) and multislice computed tomography (MSCT) to evaluate TR, TV function, and dimensions. In general, 2D-TEE showed lower diameters than MSCT with a significant but weak correlation between both imaging modalities for AP diameters (41.4 ± 7.8 mm, 47.2 ± 8.9 mm, r = 0.68, p = 0.05correlation, p = 0.03difference) and for SL diameters (41.6 ± 5.3 mm, 46.6 ± 4.6 mm, r = 0.71correlation, p = 0.05difference, p = 0.03). We found no significant correlation, however significant difference agreement, between MSCT and 2D-TEE on measures for annulus perimeter (117.6 ± 18.9 mm, 130.3 ± 21.5 mm, r = 0.3, p = 0.4correlation, p = 0.03difference) and annulus area (10.1 ± 3.3 cm2, 13.4 ± 4.1 cm2, r = 0.5, p = 0.4correlation, p = 0.04difference).

When comparing 3D-TEE with MSCT, we found a strong correlation between both imaging modalities concerning TV annulus areas (12.9 ± 2.6 cm2, 13.4 ± 4.1 cm2, r = 0.94, p = 0.0017correlation, p &lt; 0.001difference), and perimeter (130.1 ± 12.4 mm, 130.3 ± 21.5 mm, r = 0.9, p = 0.002correlation, p = 0.005difference), as well as for AP (43.8 ± 3.2 mm, 47.2 ± 8.9 mm, r = 0.73, p = 0.03correlation, p = 0.008difference) and SL diameters (44.5 ± 3.6 mm, 46.6 ± 4.6 mm, r = 0.86, p = 0.02correlation, p = 0.1difference). MSCT was not useful for TR grading and determination of TV function. In addition to conventional 2D echocardiography, only 3D-TEE allowed for direct measurement of effective regurgitant orifice area (EROA), which differed significantly from calculated EROA (p &lt; 0.05).

Conclusion

3D-TEE is highly comparable to MSCT and superior to 2D imaging for the determination of TV geometry and diameters. In contrast to MSCT, 3D-TEE allows sufficient grading and functional assessment of TR.

P985 The use of strain analysis in patients under cardiotoxic chemotherapy: possible early detection of cardiotoxicity

Cardiotoxicity is a frequent side effect of chemotherapy leading to impaired outcomes in cancer survivors. Because of that cardiooncology has recently gained more importance in clinical practice. We aim to echocardiographically evaluate the development of cardiotoxicity and to detect early signs for preventing severe cardiomyopathies by repeated strain analysis.

We included 80 patients (46.7 ± 14.7 years, 75% female) under diverse cardiotoxic chemotherapies (43.7% breast cancer, 43.7% haematological malignancy, 12.5% others). All patients underwent echocardiography before and during treatment. Follow-up echocardiography was performed approximately 5.5 ± 1.2 months after the first application of the chemotherapy. The apical four-chamber view was used to perform strain analysis employing dedicated and automated offline software as shown previously.

Eight patients deceased due to oncological complications during follow up. Twelve patients showed significant reduced left ventricle ejection fraction (LVEFbaseline 63.2 ± 4.5%, LVEFFollow-up 48.6 ± 7.8%, p = 0.02) correlated with decrease in left ventricular global longitudinal strain (LV-GLSbaseline 17.1 ± 5.2%, LV-GLSFollow-up 9.7 ± 3.2%, p = 001). All of these patients presented heart failure symptoms, mostly with dyspnoea (85% functional NYHA class &gt; II) and oedema (65%). In 15 patients we found a reduction of left ventricular global longitudinal strain from &lt;5% without relevant reduction of LVEF. However, these patients showed also heart failure symptoms. During follow up 20 patients had to be admitted due to decompensated heart failure. Four patients deceased due to cardiovascular causes.

Delta LV-GLS (LV-GLSbaseline – LV-GLSFollow-up) was found to be strongest independent predictor of mortality. Baseline LV-GLS &lt; 15% was found to be associated with mortality and frequent rehospitalisation.

Solely LVEF is insufficient to detect cardiotoxicity and to estimate prognosis of patients under cardiotoxic chemotherapy. In our small patient collective we found baseline LV-GLS &lt;15% to be an adequate parameter for prognosis estimation and delta LV-GLS &gt; 5% a strongest independent predictor for mortality in patients with preserved LVEF under cardiotoxic chemotherapy.

P908 The novel predictor for mortality in patients with functional mitral regurgitation: the modified MIDA-Score

EuroSCORE and STS-Score are used to assess surgical risk in patients with valvular heart diseases. The MIDA- Score has been recently published as a representative predictor for short- and long-term prognosis in patients with degenerative mitral regurgitation (DMR). The adequate assessment of long-term prognosis in patients with functional MR is scarce. We aim to adapt this classical score system for patients with FMR.

We retrospectively included 105 patients with FMR who underwent transcatheter mitral regurgitation therapy (TMVR) between January 2014 and August 2016 in our center. Due to the different underlying pathomechanisms of FMR, annular dilatation and impaired left ventricle function, and more elderly patient population we adapted some cut-off values to FMR patients (Age &gt; 65 to Age &gt; 75; LV-EF ≤ 60% to LV-EF ≤ 45%; sPAP≥50mmHg to sPAP≥45mmHg). Moreover, according to Cox proportional hazard analysis of our patient collective we re-calculated the weights of the risk factors: Age 2 points, Symptoms 1 point, atrial fibrillation 2 points, left atrial diameter 1 point, right ventricle systolic pressure 2 points, left ventricle end-systolic diameter 2 points, left ventricle ejection fraction 2 points. We defined three risk groups according to total points from the risk factors; Grade 1 (0-4 points): low risk, Grade 2 (5-9 points): moderate risk, Grade 3 (10-12 points): high risk.

We retrospectively included 105 patients (76.7 ± 8.8 years, 50,6% female) with symptomatic (functional NYHA class &gt; II ) moderate-to-severe FMR (PISA: 0.7 ± 0.4cm, VC width: 0.8 ± 0.3cm, EROA: 0.22cm2, RegVol: 38.1 ± 19.2ml) at surgical high risk (EuroSCORE II: 5.4 ± 3.8%, STS-Score: 4.7 ± 2.8%). We found all-cause mortality 7% at one-year follow-up. 34.1% of our collective were hospitalized.

The classical MIDA Score was not significantly correlated with mortality and rehospitalization in patients with FMR at follow-up (p = 0.5); however, the modified MIDA score was found to be a strong predictor for mortality and rehospitalization in patients with FMR (AUC: 0.89). According to multivariate analysis, the modified MIDA score was found to be superior compared to the other conventional score systems (The modified MIDA-Score HR: 4.1, p = 0.021; EuroSCORE II; HR: 1.2, p = 0.004, STS-Score; HR: 1.7, p = 0.005).

We performed Cox proportional hazard analysis to assess the weighting factor of the predictors. As a result of this, we found age (HR: 2,95, p = 0.03) as the most reliable parameter to predict the combined outcome.

The 12,5% of grade 1, 27% grade 2, 57% grade 3 patients showed combined endpoint. According to regression analysis, the modified score &gt;9 points found to be a strong predictor for high mortality and rehospitalization (OR: 3.35, p = 0.011).

We found the modified MIDA Score sufficient and extensive to assess outcomes in patients with FMR. The modified MIDA Score offers a sufficient promising tool to predict individual prognosis in patients with FMR.

43 Echocardiographical analysis of right ventricular function after transcatheter edge-to-edge repair of tricuspid regurgitation

Tricuspid regurgitation (TR) is a frequent valvular heart disease associated with increased mortality and morbidity. RV function is mostly assessed using tricuspid annulus plane systolic excursion (TAPSE), which shows merely systolic RV function and can be influenced by many other pathologies and image quality. Furthermore, the impact of dedicated percutaneous clip treatment of TR on RV global function and clinical outcomes are scarce.

We aim to perform detailed echocardiographical global RV function analysis inclusively speckle tracking of RV before and after transcatheter edge-to-edge repair of TR (TTVR).

We evaluated 50 patients, who underwent between January 2017 to March 2018 TTVR in our center. Apical four chamber images were used to perform strain analysis of RV. The systolic velocity of free RV wall (S´ Vmax) was measured through PW doppler on lateral TV annulus in color tissue Doppler. RV myocardial performance index is a parameter for systolic as well as diastolic ventricle function and can be calculated using ratio between TV closure to opening time and RV ejection time (RVCOT-RVET/RVET), which can be assessed from PW Doppler of lateral TV annulus in color tissue Doppler.

We retrospectively included 40 patients (73 ± 5.6 years, 32% female) with symptomatic (65% ascites, 95% edema, 100% NYHA &gt; II) high grade functional TR at surgical high risk (EuroSCORE II: 7.6%). 95% of all interventions were successfully performed (TR reduction at least I grade).

Our collective shows normal baseline left ventricle (LV) systolic function (Ejection fraction: 60.8 ± 4.6%) with diastolic LV dysfunction and increased LV end systolic pressure (E/E´ ratio: 17.7 ± 6.5). Baseline RV analysis presented impaired RV systolic function (TAPSE: 1.2 ± 3.2 cm, RV-FAC: 25.6 ± 9.8%, S´ Vmax: 5.6 ± 1.2cm/s) with decreased RV global longitudinal strain (RV-GLS: -8.9 ± 4.3). RV myocardial performance index (RV-MPI) was 0.51 ± 0.4 as a parameter for poor global RV function. Baseline echocardiography showed dilation of both atria (Left atrium: 80.5 ± 14.5ml, right atrium: 26.7 ± 7.8cm2) with pronounced right ventricle congestion (dilated vena cava inferior: 25.5 ± 3.4mm without breath modulation, paradoxical intraventricular septum motion, dilated RV: 57.7 ± 14.5cm2). All TR were high grade (PISA: 0.78 ± 0.3cm, VC width: 0.8 ± 0.2cm, EROA: 0.43 ± 0.1cm2, regurgitant volume: 67.1 ± 10.4ml) and functional with mostly anteroseptal (85%) coaptation defect (coaptation defect diameter: .5.7 ± 3.2mm).

The right heart failure symptoms significantly improved three months after the procedure. Patients with severe right heart failure (TAPSE &lt; 1cm) showed more often rehospitalization and limited improvements in symptoms (p = 0.02).

RV function should be more comprehensively evaluated before interventional TR therapy. The patients with already preprocedural severe right heart failure should be more critically discussed. RV-GLS and RV-MPI are strongest independent parameter of clinical outcome after TTVR.

422 Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve

The MitraClip procedure is established as a therapeutic alternative to mitral valve surgery for symptomatic patients with severe mitral regurgitation (MR) at prohibitive surgical risk. In this study, we aimed to evaluate five-year outcomes after MitraClip.

265 patients (Age: 81.4 ± 8.1 years, 46.7% female, logistic EuroSCORE: 19.7 ± 16.7%) with symptomatic MR (60,5% secondary MR: sMR) undergoing MitraClip were included. Despite procedural success of 91.3%, patients with primary MR (pMR) had a higher rate of procedural failure (sMR: 3.1%, pMR: 8.6%; p = 0.04).

Five years after MitraClip, the majority of patients presented with reduced symptoms, sustained MR reduction (≤ grade 2) and improved functional capacity (Functional NYHA class: p = 0.0001; six minutes walking test: p = 0.04) and right ventricular (RV) function.

Systolic pulmonary artery pressure (sPAP) was significantly reduced during FU only in sMR patients, (p = 0.05, p = 0.3). Despite a pronounced clinical and echocardiographical amelioration and low interventional failure, five-year mortality was significantly higher in patients with sMR (p = 0.05). The baseline level of creatinine (HR: 0.695), sPAP (HR: 0.96) and mean mitral valve gradient (HR: 0.82) were found to be independent predictors for poor functional outcome and mortality.

MitraClip showed low complication rates and sustained MR reduction with improved RV function and sPAP five years after the procedure, which was found in all patients, predominantly in patients with sMR. Despite pronounced functional amelioration with low procedure failure, sMR patients had higher five-year mortality and worse outcomes. Baseline creatinine, MVG, and sPAP were found to be independent predictors of poor functional outcomes and five-year mortality.

425 Alterations in left atrial structure and function in chronic heart failure patients with functional mitral regurgitation after MitraClip

Backround

The MitraClip procedure has been increasingly performed as an established treatment alternative for symptomatic patients with moderate to severe mitral regurgitation (MR) at prohibitive surgical risk. Left ventricular (LV) reverse remodelling following MitraClip has been shown in different studies. Left atrial (LA) volumes are believed to decrease following interventional reduction of MR. However, effects of MitraClip on LA function are not well understood.

Objectives

In this study we aimed to evaluate the effect of MitraClip on LA structure, volumes and function in chronic heart failure patients with functional MR.

Methods

All patients underwent 3D transthoracic echocardiography prior to the MitraClip procedure and at follow-up (FU) with offline evaluation of LA function and geometry using dedicated software (TomTec Image Arena, 4D LV-Analysis, Munich, Germany). FU examinations were performed 10 ± 3.4 months after the procedure.

Results

We prospectively included 75 consecutive surgical high risk (Logistic EuroScore: 17.2 ± 13.9%) patients (Age: 77 ± 9years, 22% female) with symptomatic moderate to severe MR without atrial fibrillation. All patients underwent MitraClip following heart team decision without periinterventional major complications.

Baseline echocardiography showed impaired left ventricular function (Ejection fraction (EF): 32,6 ± 11.2%), moderate to severe MR , increased systolic right ventricle pressure (RVSP: 46.1 ± 10.5 mmHg) and elevation in estimated left ventricle enddiastolic pressure (E/E´ ratio: 15.6 ± 7.3) in the patient cohort.

There was no relevant mitral stenosis after the procedure (MPG: 3.3 ± 0.5 mmHg), however the MPG increased significantly after the procedure (p = 0.05). The E/E´ ratio significantly increased at FU (15.6 ± 7.3, 24.1 ± 13.2, p = 0.05) as well. The left atrial (LA) volumes and LA-muscular mass (End-diastolic volume [LA-EDV] and end-systolic volume [LA-ESV]) significantly increased at FU (LA-EDV: 83.1 ± 39.5ml, 115.1 ± 55.3ml, p = 0.012; LA-ESV: 58.4 ± 33.4ml, 80.1 ± 43.9ml, p = 0.031; 105.1 ± 49.3gr, 145.4 ± 70.6gr, p = 0.013). LA stroke volume significantly increased after the procedure (24.6 ± 12.5ml, 34.9 ± 19.1ml, p = 0.016). LA-EF and atrial global longitudinal strain (LA-GLS) showed no significant changes at FU (LA-EF: 31.7 ± 12.8%, 31.1 ± 12.3%, p= 0.8; LA-GLS: -10.8 ± 5.4%, -9.7 ± 4.45%, p = 0.4).

Despite no relevant changes during FU, baseline E/E´ ratio (AUC: 0.652) and baseline aGLS (AUC: 0.694) were found to be independent predictors for mortality.

Conclusion

Transcatheter MV repair (TMVR) with the MitraClip procedure improves atrial stroke volume, increases atrial volumes and muscular mass acutely after the procedure. It might be explained by the acutely increased MPG and LVEDP after the MitraClip procedure. Baseline aGLS and E/E´ ratio were found to be independent predictors for mortality.

Influence of sugar experience during development on gustatory sensitivity of the honey bee

The level of response to sugar plays a role in many aspects of honey bee behavior including age dependent polyethism and division of labor. Bees may tune their sensitivity to sugars so that they maximize collection of high quality nectar, but they must also be able to collect from less profitable sources when high quality food is scarce. However, our understanding of the mechanisms by which bees can change their responsiveness to different sugars remains incomplete. To investigate the plasticity of sensitivity to sugar, bees were raised on different sugars either in vitro or in colonies. Bees raised in the incubator on diets containing mostly either fructose or glucose showed significantly more responsiveness to the majority sugar. In contrast, bees raised in colonies that only foraged on fructose or glucose responded equally well to both sugars. These data suggest that developmental plasticity for responses to sugar is masked by the feeding of worker jelly to larvae and young bees. The production of worker jelly from secretions of the hypopharyngeal and mandibular glands by nurse bees ensures that both glucose and fructose are experienced by young bees so that they respond to both sugars and will be able to exploit all future food sources.

Individual differences in learning and biogenic amine levels influence the behavioural division between foraging honeybee scouts and recruits

Animals must effectively balance the time they spend exploring the environment for new resources and exploiting them. One way that social animals accomplish this balance is by allocating these two tasks to different individuals. In honeybees, foraging is divided between scouts, which tend to explore the landscape for novel resources, and recruits, which tend to exploit these resources. Exploring the variation in cognitive and physiological mechanisms of foraging behaviour will provide a deeper understanding of how the division of labour is regulated in social insect societies. Here, we uncover how honeybee foraging behaviour may be shaped by predispositions in performance of latent inhibition (LI), which is a form of non-associative learning by which individuals learn to ignore familiar information. We compared LI between scouts and recruits, hypothesizing that differences in learning would correlate with differences in foraging behaviour. Scouts seek out and encounter many new odours while locating novel resources, while recruits continuously forage from the same resource, even as its quality degrades. We found that scouts show stronger LI than recruits, possibly reflecting their need to discriminate forage quality. We also found that scouts have significantly elevated tyramine compared to recruits. Furthermore, after associative odour training, recruits have significantly diminished octopamine in their brains compared to scouts. These results suggest that individual variation in learning behaviour shapes the phenotypic behavioural differences between different types of honeybee foragers. These differences in turn have important consequences for how honeybee colonies interact with their environment. Uncovering the proximate mechanisms that influence individual variation in foraging behaviour is crucial for understanding the ecological context in which societies evolve.

International study on nurses' views and experiences of compassion

BACKGROUND

Compassion is considered the cornerstone of nursing practice. However, the recent failures in delivering high-quality compassionate nursing care in the UK's National Health Service have brought the topic of compassion to the attention of the public, service providers, policy makers and academics.

AIM

The aim of this study was to explore the nurses' views and experiences of a number of compassion-related issues in nursing and describe similarities and differences at an international level as well as from the different nursing roles of the participating nurses.

METHODS

An exploratory, cross-sectional descriptive study, using the International Online Compassion Questionnaire. A total of 1323 nurses from 15 countries completed the questionnaire.

RESULTS

The majority of participants (59.5%) defined compassion as "Deep awareness of the suffering of others and wish to alleviate it" but definitions of compassion varied by country. Of participants, 69.6% thought compassion was very important in nursing and more than half (59.6%) of them argued that compassion could be taught. However, only 26.8% reported that the correct amount and level of teaching is provided. The majority of the participants (82.6%) stated that their patients prefer knowledgeable nurses with good interpersonal skills. Only 4.3% noted that they are receiving compassion from their managers. A significant relationship was found between nurses' experiences of compassion and their views about teaching of compassion.

CONCLUSION

Our study is unique in identifying the views and experiences of nurses from 15 different countries worldwide. The findings reveal that compassion is neither addressed adequately in nursing education nor supported in the practice environment by managers.

LIMITATIONS

Self-report bias was inherent to our survey study design. Furthermore, the individual cultural differences and similarities in the findings are difficult to extrapolate owing to the fact that our analysis was at country level, as well as at the level of the participating nurses.

IMPLICATIONS FOR NURSING POLICY

Understanding the influence of culture on nurses' views about compassion is critical in the current multicultural healthcare environment and merits further research. This will potentially drive changes in nursing education (ensuring that compassion is taught to nurses) and in the way healthcare leaders and managers foster a compassionate culture within their organizations (e.g. by leading by example and compassionate to their staff).

Effects of different cavity-disinfectants and potassium titanyl phosphate laser on microtensile bond strength to primary dentin

AIM

The aim of this in vitro study was to compare the effects of different cavity-disinfectants and potassium titanyl phosphate (KTP) laser on microtensile bond strength to primary dentin. Chlorhexidine (CHX), propolis (PRO), ozonated water (OW), gaseous ozone (OG) and KTP laser were used for this purpose.

METHODOLOGY

Twelve primary molar teeth were used in this study. One-third of the teeth (from coronal portion) were removed to obtain flat surfaces. After applying the cavity-disinfectants, an adhesive (prime and bond NT) was applied to dentin surfaces, and composite crowns were built up. One group received no pretreatment and was set as a control (CONT). Ten sticks were obtained from these samples and were stressed in tension until failure using a universal testing machine and the data were recorded.

RESULTS

The mean strength values (in MPa) of the sticks were OW (11.12) > KTP (9.58) > CHX (7.58) > PRO (7.42) > CONT (6.38) > OG (5.84) and OW showed significantly higher results than the other groups, except KTP group (P < 0.05).

CONCLUSIONS

OW and KTP might be used safely without compromising the bond strength of restorative materials.

Thrombolytic therapy in a patient with inferolateral myocardial infarction after carbon monoxide poisoning

INTRODUCTION

ST segment elevation myocardial infarction (STEMI) due to coronary artery occlusion caused by intracoronary thrombosis in the setting of acute carbon monoxide (CO) poisoning is a very rare presentation. We present a case of intracoronary large and mobile thrombus formation after CO poisoning.

CASE PRESENTATION

A previously healthy 50-year-old woman was referred for CO poisoning. She had chest pain after exposure to CO. Her initial mental status was preoccupied with chest pain. Her initial CO fraction was 28.1%, and initial laboratory data showed creatine kinase-myocardial isoenzyme of 134 U/L (upper limit 25 U/L) and troponin I of >50 ng/mL (upper limit 0.06 ng/mL). Electrocardiography was carried out on admission, revealing an ST segment elevation in the inferolateral leads. After initial evaluation, coronary angiography was performed and an intracoronary large mobile thrombus was seen in the proximal left anterior descending (LAD) artery with no significant stenosis. We administered tenecteplase with heparin. After the thrombolytic therapy, ST elevation in the inferolateral leads resolved. Repeat angiography was performed after 24 h; the thrombus in LAD had resolved. The patient was discharged after 5 days, with persistent Q wave in the inferior leads and mild hypokinesia of the inferoposterior wall suggesting myocardial injury.

CONCLUSION

We describe intracoronary thrombus formation induced by CO poisoning. Because intracoronary thrombus can result in myocardial infarction, its consideration following CO poisoning is important. Patients with CO poisoning who have symptoms of STEMI should be carefully evaluated with serial electrocardiograms, cardiac biomarkers, and an echocardiogram. When there is evidence of acute myocardial injury, a primer in coronary angiography can determine which patients could benefit from intervention.

Accuracy of three different apex locators and visual exam in primary teeth with and without root resorption in vitro

AIM

The aim of this study was to evaluate the accuracy and reliability of three apex locators (EndoMaster, Raypex, DentaPort ZX) and visual assessment in primary molar teeth in vitro.

MATERIALS AND METHODS

Twenty-four extracted human primary molar teeth with and without root resorption were used in this study. After endodontic access preparation, root canal length was visually measured by means of a K file; then the teeth were embedded into alginate and the roots were measured again by mans of the three apex locators. The results were collected in SPSS 15.0 and statistical evaluations were completed by one-way ANOVA and Kruksal-Wallis test.

RESULTS

The measurements closest to the visually determined length were obtained with EndoMaster. No statistically significant differences were found between visual and apex locators lengths (p>0.05).

CONCLUSION

Within the limitations of this study, the use of apex locators would be useful in the endodontic treatment of primary teeth.

Do elevated serum IgM levels have to be included in probable diagnosis criteria of patients with ataxia-telangiectasia?

Ataxia-telangiectasia (AT) is a rare multisystem, neurodegenerative genetic disorder that is characterised by progressive neurological abnormalities, oculocutaneous telangiectasias and immunodeficiency. Delay in diagnosis or misdiagnosis is probable due to its wide clinical heterogeneity in infancy. Recurrent sinopulmonary infections are often the only presenting symptom and usually patients have decreased immunoglobulins. A total 10% of patients who present with decreased serum immunoglobulin G and A and with normal or elevated immunoglobulin M levels are often misdiagnosed as hyperimmunoglobulin M syndrome. Definitive diagnosis is made if a patient with progressive cerebellar ataxia has a disease causing mutation on the ATM gene. Ataxia-telangiectasia guideline of the European Society for Immunodeficiencies defines the probable diagnosis criteria. We evaluated twenty ataxia-telangiectasia patients (mean age 13.8±4.1 years) retrospectively who were followed-up for a mean of 38.6±27.0 months. Twelve patients had a family history of consanguinity. A total of 80&#x0025; patients suffered from various infections. Neoplasms occurred in three of them. Patients showed immunological abnormalities as low IgG (45%), low IgA (65%) and elevated IgM (60%) levels. CD3+CD4+ T lymphocyte frequency was low in 45% patients. The mean AFP concentration at the diagnosis was 191.9±140.1 ng/mL and the raised IgM values did not show any statistically significant relationship with high AFP concentrations. Frequency of the elevated IgM concentrations in (60%) patients raises the concerns about thinking this finding has to be accepted as a probable diagnosis criterium.

Relationship between primary lesion metabolic parameters and clinical stage in lung cancer

OBJECTIVES

The relation of PET-derived parameters as maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), metabolic tumor volume (MTV) with clinical stage in lung cancer and correlation of SUVmax of primary tumor and that of metastatic lesion was studied in lung cancer patients.

MATERIALS AND METHODS

Patients with lung cancer who were referred for FDG PET/CT were included in the study.

RESULTS

PET/CT scans and pathology reports of 168 patients were assessed. A total of 146 (86.9%) of these patients had a diagnosis of non-small cell lung cancer (NSCLC) and 22 (13.1%) had small cell lung cancer (SCLC). Metabolic parameters such as SUVmax, TLG and MTV showed significant differences in all the stages in NSCLC patients (p<0.001). However, after tumors sizes <25 mm were excluded, no significant differences in SUVmax between stages were observed. No significant differences were found between these metabolic parameters and limited or extended disease SCLC. Tumor diameter correlated with primary tumor SUVmax and significant correlations between primary lesion SUVmax and metastatic lesion SUVmax were found.

CONCLUSIONS

Although differences were found regarding indices between stages of NSCLC cases, SUVmax differences between stages seem to be caused by underestimation of SUVmax in small lesions. Other glucose metabolism indexes such as MTV and TLG show promising results in terms of prognostic stratification. Future studies are needed for better understanding of their contribution to clinical cases.

Is QUALIOST appropriate for the patients with orthotopic liver transplantation in measuring quality of life?

The quality of life questionnaire in osteoporosis (QUALIOST) measures the impact of this condition. The purpose of this study was to assess the psychometric properties of QUALIOST among 38 orthotopic liver transplantation (OLT) patients who had been diagnosed with osteoporosis or osteopenia versus 42 control subjects with osteoporosis or osteopenia associated with other conditions. Bone mineral density (gr/cm(2)) measurements were performed by dual-energy X-ray absorptiometry as well as thoracic and lumbar spine radiographs to assess fractures. Reliability studies evaluated by intraclass correlation coefficients (ICC) and internal consistency (Cronbach α). For the validity studies, correlation analysis was performed between this scale and Short Form-36 (SF-36) results. The questionnaire was filled out completely by all the patients with 0.9% and 1.3% of omitted answer rates for OLT and control patients. ICC and Cronbach's α values were good for all domains with values above .90. In both groups we observed significant negative high correlations between the domains of the questionnaire and all SF-36 dimensions (P < .001). At least one vertebral fracture was diagnosed in 17 (44.7%) and 20 (47.6%) patients with OLT and control respectively. The comparison analysis revealed that the scores of QUALIOST of patients with vertebral fracture were significantly higher than those without a fracture in both groups (P < .05). In conclusion, we evaluated the validity and reliability of a scale measuring quality of life in patients who had osteoporosis secondary to OLT. The results showed that the Turkish QUALIOST showed acceptable validity and reliability in these patients.

Evaluation of changes in quality of life among Turkish patients undergoing ventricular assist device implantation

BACKGROUND

Ventricular assist device (VAD) application has become an increasingly common method to treatment end-stage heart failure. In this study we evaluated the effect of VAD implantation upon the quality of life among Turkish patients with end-stage heart failure.

METHODS

Twenty-eight VAD implantation patients included 3 (10.7%) with biventricular support using the Berlin Heart Excor; 15 (53.6%), left ventricular support with the Berlin Heart Excor; and 10 (35.7%), Heartware implantation for left ventricular support. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) and Short Form 36 (SF-36) Health Questionnaire were used to assess changes in the quality of life (QOL).

RESULTS

Of the 28 patients, 2 were females (7.1%) and 26 were males (92.9%) of overall mean age of 44.6 ± 15.3 years (range, 8-66). Preoperative mean score of MLHFQ was significantly improved at 200.4 ± 147.4 days follow-up (72.8 ± 11.5 vs 13.7 ± 10.5; P < .05). SF-36 physical scores and mental scores were improved postoperatively (physical scores, 20.0 ± 24.4 vs 70.2 ± 19.9; mental scores, 38.4 ± 18.8 vs 73.9 ± 15.7; P < .05). No significant relation was observed between the postoperative scores of questionnaires and type of surgery. More improvement in postoperative MLHFQ scores was seen in patients younger than 45 years of age (P = .027). The severity of chronic heart failure (CHF) regressed from New York Heart Association (NYHA) class IV to NYHA class II in 26 and to NYHA class III in 2 patients (P = .000).

CONCLUSION

The QOL among patients with end-stage heart failure improved dramatically soon after VAD implantation.

Expectant management of preterm premature rupture of membranes remote from term with exiguous amniotic fluid and a prolonged latency period: report of two cases

Management of preterm premature rupture of membranes (PPROM) is a very challenging issue for the obstetricians. We report two cases of PPROM occurring in early gestation remote from term (both < 26 weeks) with exiguous amniotic fluid (amniotic fluid index of < or =2 cm) that were managed successfully by conservative treatment and resulted in a latency period of almost two months. This treatment option might be feasible in carefully selected patients following meticulous evaluation and warrants further research.

Reduced gray matter volume in the frontotemporal cortex of patients with early subacute sclerosing panencephalitis

BACKGROUND AND PURPOSE

Subacute sclerosing panencephalitis (SSPE) is a persistent infection of the central nervous system by the measles virus. Patients in the initial stages of SSPE show behavioral symptoms and usually normal cranial MR imaging findings. We aimed to investigate the gray matter volume changes in patients with early SSPE.

MATERIALS AND METHODS

Seventeen patients with SSPE with normal cranial MR imaging findings and 30 sex- and age-matched control subjects were included in the study. Clinical parameters of the patients were quantified by using a neurologic disability index (NDI) as defined previously. We obtained T1-weighted magnetization-prepared rapid acquisition gradient echo images from the patients and control subjects, and we applied an optimized method of voxel-based morphometry. We performed a cross-sectional analysis to search the gray matter volume differences between the patients and control subjects. The correlation between the gray matter distribution and the duration of symptoms, immunoglobulin G index, and NDI scores was tested.

RESULTS

We found that the cortical gray matter volume of patients was reduced in the frontotemporal regions including the bilateral cingulate cortex and amygdala. There was no correlation between the gray matter distribution of patients and the duration of symptoms or the NDI scores.

CONCLUSIONS

The current study demonstrated gray matter volume reduction in the frontotemporal cortex of patients with SSPE without any apparent lesions on conventional MR imaging. Because the cingulate cortex and amygdala are involved in emotion processing, gray matter loss in these regions may contribute to the development of early behavioral symptoms of SSPE.