Microstructural alterations in the locus coeruleus-entorhinal cortex pathway in Alzheimer's disease and frontotemporal dementia

INTRODUCTION

We investigated in vivo the microstructural integrity of the pathway connecting the locus coeruleus to the transentorhinal cortex (LC-TEC) in patients with Alzheimer's disease (AD) and frontotemporal dementia (FTD).

METHODS

Diffusion-weighted MRI scans were collected for 21 AD, 20 behavioral variants of FTD (bvFTD), and 20 controls. Fractional anisotropy (FA), mean, axial, and radial diffusivities (MD, AxD, RD) were computed in the LC-TEC pathway using a normative atlas. Atrophy was assessed using cortical thickness and correlated with microstructural measures.

RESULTS

We found (i) higher RD in AD than controls; (ii) higher MD, RD, and AxD, and lower FA in bvFTD than controls and AD; and (iii) a negative association between LC-TEC MD, RD, and AxD, and entorhinal cortex (EC) thickness in bvFTD (all p < 0.050).

DISCUSSION

LC-TEC microstructural alterations are more pronounced in bvFTD than AD, possibly reflecting neurodegeneration secondary to EC atrophy.

Highlights

Microstructural integrity of LC-TEC pathway is understudied in AD and bvFTD.LC-TEC microstructural alterations are present in both AD and bvFTD.Greater LC-TEC microstructural alterations in bvFTD than AD.LC-TEC microstructural alterations in bvFTD are associated to EC neurodegeneration.

Unsupervised [18F]Flortaucipir cutoffs for tau positivity and staging in Alzheimer's disease

PURPOSE

Several [18F]Flortaucipir cutoffs have been proposed for tau PET positivity (T+) in Alzheimer's disease (AD), but none were data-driven. The aim of this study was to establish and validate unsupervised T+ cutoffs by applying Gaussian mixture models (GMM).

METHODS

Amyloid negative (A-) cognitively normal (CN) and amyloid positive (A+) AD-related dementia (ADRD) subjects from ADNI (n=269) were included. ADNI (n=475) and Geneva Memory Clinic (GMC) cohorts (n=98) were used for validation. GMM-based cutoffs were extracted for the temporal meta-ROI, and validated against previously published cutoffs and visual rating.

RESULTS

GMM-based cutoffs classified less subjects as T+, mainly in the A- CN (<3.4% vs >28.5%) and A+ CN (<14.5% vs >42.9%) groups and showed higher agreement with visual rating (ICC=0.91 vs ICC<0.62) than published cutoffs.

CONCLUSION

We provided reliable data-driven [18F]Flortaucipir cutoffs for in vivo T+ detection in AD. These cutoffs might be useful to select participants in clinical and research studies.

Hematopoietic Stem Cell (HSC)-Independent Progenitors Are Susceptible to Mll-Af9-Induced Leukemic Transformation

Infant acute myeloid leukemia (AML) is a heterogeneous disease, genetically distinct from its adult counterpart. Chromosomal translocations involving the KMT2A gene (MLL) are especially common in affected infants of less than 1 year of age, and are associated with a dismal prognosis. While these rearrangements are likely to arise in utero, the cell of origin has not been conclusively identified. This knowledge could lead to a better understanding of the biology of the disease and support the identification of new therapeutic vulnerabilities. Over the last few years, important progress in understanding the dynamics of fetal hematopoiesis has been made. Several reports have highlighted how hematopoietic stem cells (HSC) provide little contribution to fetal hematopoiesis, which is instead largely sustained by HSC-independent progenitors. Here, we used conditional Cre-Lox transgenic mouse models to engineer the Mll-Af9 translocation in defined subsets of embryonic hematopoietic progenitors. We show that embryonic hematopoiesis is generally permissive for Mll-Af9-induced leukemic transformation. Surprisingly, the selective introduction of Mll-Af9 in HSC-independent progenitors generated a transplantable myeloid leukemia, whereas it did not when introduced in embryonic HSC-derived cells. Ex vivo engineering of the Mll-Af9 rearrangement in HSC-independent progenitors using a CRISPR/Cas9-based approach resulted in the activation of an aberrant myeloid-biased self-renewal program. Overall, our results demonstrate that HSC-independent hematopoietic progenitors represent a permissive environment for Mll-Af9-induced leukemic transformation, and can likely act as cells of origin of infant AML.

Acute kidney injury and acute kidney disease in high-dose cisplatin-treated head and neck cancer

Background

In locally advanced head and neck squamous cell carcinoma (LA-SCCHN) at least 200mg/m² (standard dose 300 mg/m²) of cisplatin concomitant with radiotherapy represents the standard of care, both in postoperative and conservative settings. Nevertheless, high dose administration every 3 weeks is often replaced with low dose weekly cisplatin to avoid toxicities like kidney injury, though often failing to reach the therapeutic dose. Our aim was to investigate the incidence of renal impairment in the real-life setting, integrating high dose cisplatin with adequate supportive therapy, and to explore both Acute Kidney Injury (AKI) and Acute Kidney Disease (AKD), a recently described clinical renal syndrome that encompasses functional alterations of the kidney lasting fewer than 3 months.

Methods

One hundred and nine consecutive patients affected by LA-SCCHN and treated with at least a cumulative dosage of 200 mg/m² of cisplatin concomitant with radiotherapy were enrolled in this prospective observational study.

Results

AKI was reported in 12.8% of patients, 50% of whom were stage 1 (KDIGO criteria), while 25.7% of the cohort developed AKD. Patients with baseline estimated Glomerular Filtration Rate (eGFR) < 90 ml/min showed a higher incidence of AKD (36.2% vs 17.7%). Hypertension, baseline eGFR, and therapy with Renin-angiotensin-aldosterone system inhibitors proved to be significant factors associated with both AKI and AKD.

Conclusion

AKI and AKD are not rare complications of high-dose cisplatin, but an appropriate prevention strategy and accurate monitoring of patients during treatment could lead to a reduction of the burden of these conditions.

Metacognitive interpersonal therapy in borderline personality disorder: Clinical and neuroimaging outcomes from the CLIMAMITHE study-A randomized clinical trial

Different psychotherapeutic approaches demonstrated their efficacy but the possible neurobiological mechanism underlying the effect of psychotherapy in borderline personality disorder (BPD) patients is poorly investigated. We assessed the effects of metacognitive interpersonal therapy (MIT) on BPD features and other dimensions compared to structured clinical management (SCM). We also assessed changes in amygdala activation by viewing emotional pictures after psychotherapy. One hundred forty-one patients were referred and 78 BPD outpatients were included and randomized to MIT or SCM. Primary outcome was emotional dysregulation assessed with the Difficulties in Emotion Regulation Scale (DERS). We also assessed BPD symptomatology, number of PD criteria, metacognitive abilities, state-psychopathology, depression, impulsiveness, interpersonal functioning, and alexithymia. A subset of 60 patients underwent functional magnetic resonance imaging before and after 1 year of psychotherapy to assess amygdala activation by viewing standardized emotional pictures (secondary outcome). DERS scores decreased in both groups (time effect p < .001). The Cohen's d effect size for change (baseline posttreatment) on DERS was very large (d = 0.84) in MIT, and large (d = 0.76) in SCM. Both groups significantly improved in depressive symptoms, state-psychopathology, alexithymia, and interpersonal functioning. MIT showed larger effect on metacognitive functions than SCM (Time × Group p < .001). Both interventions showed a significant effect on BPD symptomatology although SCM group showed a larger decrease. On the contrary, MIT group showed larger decrease in impulsivity and number of PD criteria. Interestingly, both MIT and SCM modulated amygdala activation in BPD patients. MIT is a valid and effective psychotherapy for BPD with an impact on amygdala activation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Impact of a Mediterranean-like Diet with Controlled Protein Intake on the Onco-Nephrological Scenario: Time for a New Perspective

Chronic kidney disease (CKD) represents a frequent comorbidity in cancer patients, especially for patients affected by urological cancers. Unfortunately, impaired kidney function may limit the choice of adequate oncological treatments for their potential nephrotoxicity or due to contraindications in case of a low glomerular filtration rate. For these patients, tailored nephrological and nutritional management is mandatory. The K-DIGO guidelines do not define whether the nutritional management of CKD could be useful also in CKD patients affected by urological cancer. In fact, in clinical practice, oncological patients often receive high-protein diets to avoid malnutrition. In our study, we investigated the nutritional and nephrological impact of a Mediterranean-like diet with a controlled protein intake (MCPD) on a cohort of 82 stage III-IV CKD patients. We compared two cohorts: one of 31 non-oncological CKD patients and the other of 51 oncological patients with CKD. The use of an MCPD had a favorable impact on both the oncological and non-oncological CKD patients with an amelioration in all the investigated parameters and with a better quality of life, with no cases of malnutrition or AKI.

MO165: The Controversial Role of Proteinuria and Urinary Output After Radical Nephrectomy in the Development Of Acute Kidney Injury: Double Agents

BACKGROUND AND AIMS

Acute kidney injury (AKI) is increasingly common and associated with adverse short- and long-term outcomes in oncological patients who require radical nephrectomy (RN) for the presence of renal cancer. As defined by the KDIGO Criteria classification system, the diagnosis of AKI is nowadays based on changes in the serum creatinine levels (sCr) or urine output. However, these parameters often underestimate the severity of renal damage and therefore recent insights have resulted in the implementation of proteinuria as means of more accurately assessing for AKI. Proteinuria represents indeed an indicator of both glomerular and renal endothelial injury in chronic disease (CKD), whereas in AKI the presence of proteinuria could be derived from a tubular dysfunction. In the RN scenario, it is still debatable if the development of a mild to severe proteinuria after surgery could be considered a marker of renal damage resulting in AKI or, on the opposite, could be a physiological sign of adaptive compensatory hyperfiltration promoted by the remanent counterlateral kidney.

 The aim of our study was to investigate if the development of a postoperative proteinuria plays a positive or negative role in the prevention of AKI in a consecutive cohort of nephrectomized patients affected by renal cancer.

METHOD

We enrolled a consecutive cohort of 131 patients who underwent RN due to the presence of a kidney mass suspected of malignancy from 2018 to 2021 in a tertiary care urological Institution.

The following data were considered: age, gender, body mass index (BMI), smoke, TNM staging, Fuhrman grading, hypertension, diabetes, cardiovascular events, dyslipidaemia, medical therapy (ACE-inhibitors (ACEi), angiotensin II receptor blockers (ARBs), calcium antagonists, beta blockers and diuretics), proteinuria in 24 h, urine volume in 24 h, preoperative haematocrit and haemoglobin.

Serum creatinine (s-Cr) values [Kinetic Picrate standardized (COBAS C 800) for IDMS] were collected before surgery (t 0) and at 24, 48 and 72 h after surgery and at dismissal (respectively t 1, t 2 and tf) to detect renal function fluctuations and the subsequent risk of AKI. GFR was estimated at baseline using CKD-EPI 2012 and MDRD formula. The level of proteinuria was measured at 24 h postoperative and was standardized on the urine volume. Each operated patient underwent the same pre-peri- and postoperative medical protocol in terms of surgical and anesthesiologic management. Patients affected by pre-existing medical nephropathies with proteinuria were excluded.

Comparisons between groups were performed using the Kruskal–Wallis rank sum test for numerical variables and Pearson's Chi-squared test for categorical variables. Logistic regression was used to identify variables odds ratio for AKI onset after surgery.

RESULTS

Descriptive analysis is shown in Table 1. Our analysis surprisingly underlined that 66% of overall patients experienced AKI after surgery. Moreover, the analysis showed a significant difference (P value &lt; .05) between the AKI cohort and the non-AKI group concerning basal serum creatinine (sCr), eGFR using both CKD-EPI and MDRD and postoperative urine volume. In particular, the lower the basal sCr or eGFR, the higher was the risk of developing AKI. Concerning the urine output, the median volume of AKI population was significantly less in respect to their counterpart, but far from the critical definition of oliguria or anuria (Table 1 and Figure 1). On the contrary, no evidence related to a possible prognostic role of proteinuria was underlined.

CONCLUSION

Our work underlined that proteinuria does not represent a valid biomarker for AKI development after RN. On the contrary, basal eGFR, serum creatinine and postoperative urinary volume could be promising tools to predict and follow the acute renal damage after RN.

MO189: The Clinical Relevance of Measured GFR in Patients with Solitary Kidney after Radical Nephrectomy: The Estimation is not Enough

BACKGROUND AND AIMS

Chronic kidney disease (CKD) represents the major postoperative long-term complication in patients who undergo radical nephrectomy (RN) for the presence of a renal mass. The development of a mild to severe grade of CKD can dramatically change the lifespan of this category of patients who can experience not only an augmented rate of cardiovascular diseases but also cancer recurrence and oncological therapies based on nephrotoxic agents. Therefore, preventive strategies for reducing the risk of CKD are strictly required. Among them, one of the most important tools is represented by the correct assessment of renal function. In fact, especially in the oncological scenario, there are various causes of factitious elevation or reduction of serum creatinine due to the frequent modification of body composition, measurement interference with the assay and altered tubular secretion. Nevertheless, the use of estimated GFR based on serum creatinine levels remains nowadays the most common method to define renal function in RN patients, both in the oncological and in the urological universe. The aim of this study was to determine the extent of the error of eGFR compared to the mGFR in a consecutive prospective cohort of RN patients who remained with a solitary kidney.

METHOD

A total consecutive cohort of 115 RN patients enrolled in a single tertiary institution between 2018 and 2021 was collected in order to compare the most common eGFR formulas used by physicians (Cockroft-Gault, MDRD, CKD-EPI based on serum creatinine and/or serum cystatin and the new eGFR equation based on creatinine and cystatin without race adjustment) with the most widespread mGFR method (Iohexol Plasma Clearance). The mGFR technique together with the serum creatinine/cystatin measurement was performed after 12 months from the operation in order to consider a steady state for the chronic renal function. All clinical variables were reported for each pt. CKD classification was defined accorded to K-DIGO 2012 guidelines.

The agreement between eGFR and mGFR was evaluated using bias (as median of difference), precision (as interquartile range of difference-IQR), accuracy (as P30) and total deviation index (TDI). The differences between cohorts were evaluated with Fisher's exact test and Chi-squared test for ordinal characteristics and Wilcoxon rank sum test for continuous variables. Data analysis was performed using programming language R and Python.

RESULTS

Clinical data were as follows: median age 66 (IQR 27.66), M/F ratio 4.48, median BMI 24.6 (IQR: 0.003, 24.6). 51.3% of patients had hypertension, 10.4% were diabetics. The median creatinine level in the overall population was 1.49 mg/dL (IQR: 0.8, 1.49), the median cystatin level was 1.33 mg/dL (IQR: 0.55, 1.33). Based on iohexol plasma clearance, 0.87% patients were classified in CKD in stage 1, 17.39% in stage 2, 39.13% in stage 3a, 25.22% in stage 3b, 16.52% in stage 4 and 0.87% in stage 5. Surprisingly, a non-negligible error was reported in each CKD class with a huge discrepancy between the eGFR formulas and the gold standard method (Figures 1 and 2), suggesting the pivotal role of mGFR in the clinical decision-making algorithm for RN patients.

CONCLUSION

In daily clinical practice, an appropriate nephrological tailored follow-up based on mGFR is mandatory for RN patients with a solitary kidney. In fact, a simple renal evaluation using eGFR can only increase the risk of clinical errors, sometimes underestimating and sometimes overestimating the real renal function with important medical consequences.

MO192: Renal Outcomes in High Dose Cisplatin in Locally Advanced Squamous Cell Cancer of the Head and Neck: A Monocentric Experience

BACKGROUND AND AIMS

Head and neck cancer (HNC) represents the sixth most common neoplasm worldwide, accounting for 400 000 deaths globally every year. Among HNC, the squamous cell carcinoma (SCCHN) is the most aggressive histology, being responsible for more than 90% of cases. The overall 5-year survival rate goes from 33% to 68% according to risk factors and primary site.

In clinical practice, at least two cycles of three-weekly high-dose cisplatin (100 mg/m2) concomitant to radiotherapy represents the standard of care given LA-SCCHN with a curative intent, both in postoperative and conservative settings.

However, concurrent high-dose cisplatin is associated with significant acute and late toxicities. Acute kidney injury (AKI) is a common and serious side effect of high-dose cisplatin-based concurrent chemoradiation (CRT). AKI is a predictor of immediate and long-term adverse outcomes. The aim of this study was to investigate the nephrotoxicity of chemotherapy in real life of LA-SCCHN patients during and after treatment with high-dose cisplatin-based CRT, with a particular focus on AKI onset.

METHOD

Ninety-three consecutive patients affected by LA-SCCHN and treated with high-dose cisplatin-based CRT were enrolled in a prospective observational monocentric study. All patients received adequate supportive care such as SF 750 mL + 16 mEq MgSO4 IV 200 mL/h before and after cisplatin administration (a total of 1500 mL at day 0 and again at day 1), with 375 mL mannitol 10% if diuresis after hydration was less than 100–200 mL/h and dexamethasone 12 mg IV as chemo premedication at day 0 and 8 mg PO at days 1 to 3 as antiemetic prophylaxis followed by 6 days of steroid progressive decalage. Demographic data, medical history, and clinical, laboratory and histological data at presentation were reported from the medical records. Serum creatinine was recorded at baseline and after each cycle of treatmentat day 1 and day 10, respectively. eGFR was calculated using CKD-EPI 2012 formula. Bayesian linear regression was used to evaluate the impact of the clinical and pathological features on eGFR decay through cycles and AKI incidence.

RESULTS

The cohort was composed of 93 patients with a median age of 59 years, M/F ratio 2.4, median BMI 24.9 (IQR: 22.3, 27.4), median eGFR 92.2 mL/min. A total of 58% of patients presented basal eGFR &gt; 90 mL/min, while 42% &lt;90 mL/min (only 4 patients with eGFR &lt; 60 mL/min). Approximately 34.4% patients presented hypertension, and the 8.6% were diabetics.

AKI onset was 22.6% in the overall cohort: among those 21 patients who developed AKI, no one showed stage II-III AKI according to the KDIGO classification. Using a definition of AKI based only on an increase in serum creatinine &gt; 1.5 higher than 1.5 times the baseline value, AKI incidence was 14% with a significative difference (P = .04) between patients with baseline eGFR &gt; 90 mL/min and patients with eGFR &lt; 90. Statistical analysis preformed using a logistic regression model showed a correlation between arterial hypertension and AKI incidence, while other comorbidities (such as diabetes) and concurrent medications were not associated with an increased in AKI incidence.

CONCLUSION

AKI was a common complication of high-dose cisplatin treatment in our LA-SCCHN patients’ cohort (22.6%): interestingly, the totality of AKI cases was represented by stage I AKI. The main risk factor for AKI development was a diagnosis of arterial hypertensions (Figure 1), while no correlation with concomitant medications and diabetes was found. The overall AKI incidence in our cohort was lower than reported in previous Studies, likely due to the use of a preventive protocol based on hydration and mannitol use; among those patients who developed AKI, no modification in cisplatin treatment scheme were needed, particularly all the patients reached a cumulative cisplatin dose ≥200 mg/m2.

MO177: The Impact of a Low-Normal Protein High Calorie Diet on the Nephrological Scenario and Perceived Quality of Life of Oncourological Patients with Chronic Kidney Disease

BACKGROUND AND AIMS

Nutritional therapy (NT) based on controlled protein intake represents a cornerstone in the management of chronic kidney disease (CKD). However, the international guidelines do not precisely define an adequate protein intake for onconephrological patients. The aim of our study is to investigate whether a low-normal protein high calorie (LNPHC) diet in a nephrologist-nutritionist combined approach (NNCA) and aimed at CKD patients can also be effective in improving the renal function in oncological patients which developed renal disease, while maintaining a high quality of life and a healthy nutritional status.

METHOD

A consecutive cohort of 113 patients was enrolled in the Urological Department at San Raffaele Scientific Institute between 2018 and 2021. Inclusion criteria were: age (&gt;18 years), eGFR (&lt;60 mL/min/1.73 m2), Malnutritional Screening Tool (MST &lt; 2), Urological Cancer aggressiveness (no metastatic process) and informed consent (signed). We divided the total cohort in two matched subgroups; case (CS: onco-nephrological pts with urological malignancies) and control (CT: nephrological pts) with a 2.1 ratio. Each patient underwent an initial nephrological and nutritional evaluation and was subsequently subjected to a conventional CKD LNPHC diet integrated with aproteic foods (0.7–1 g/kg/die: calories: 30–35 kcal per kg body weight/die) for a period of 6 months (+/– 2 months). The diet was based on the estimated glomerular filtration rate (CKD-EPI 2021 Creatinine formula), comorbidities and nutritional status. MST, RAPA test, body mass index (BMI), phase angle (PA), fat mass percentage (FM%), fat-free mass index (FFMI), body cell mass index (BCMI), extracellular/intracellular water ratio (ECW/ICW), waist/hip circumference ratio (WHC), lab test exams and clinical variables were examined at baseline and after 6 months. To evaluate the impact of the combined approach on perceived quality of life, multiple 8 scale assessments in a generic QoL-Short Form 36 (SF36) questionnaire were administered to patients. Statistical analysis: Kruskal–Wallis rank-sum test; data analysis: R programming language and RStudio integrated development environment.

RESULTS

The combined treatment produced eGFR and urea parameter improvements (49% of patients improved eGFR, 65% uremia) without negatively altering the anthropometrical outcomes. The nutritional status, as assessed by the MST, was preserved in both groups during the study. We notice specially an improvement in BMI (average deviation from ideal weight: 0.5 kg/h2 CS pts; 0.7 kg/h2 CT pts), an increase of PA [average difference (AD): 3.0°CS pts; 1.6°CT pts], BCMI (AD: 0.6 CS pts; 4.0 CT pts) and FFMI (AD: 0.1 female and 0.1 male for CS pts; 2.9 female and 1.1 male for CT pts) and a favourable decrease of WHC ratio (AD:–0.01 female and–0.02 male for CS pts; ––0.01 female and–0.01 male for CT pts), FM percentage (AD: –1.2 female and 1.2 male CS pts;–2.7 female and 2.9 male CT pts) and ECW/ICW (AD:–0.02 CS pts;–0.03 CT pts). Finally, RAPA test highlight that all patients considered themselves ameliorated after the diet period in term of lifestyle and Short-Form Health SF36 Questionnaire confirmed satisfaction for all eight domains of health including physical and mental health.

CONCLUSION

Our study suggests that LNPHC diet ameliorates the nephrological scenario, the metabolic complications and the nutritional perspective in uro-oncological CKD pts. Following NNCA, perceived quality of life has been pushed towards high scores and does not appear to be influenced by physical health and emotional status; however, there is a worsening in health change despite they describe their current health status as more than satisfactory. This may be explained by the fact that harsh clinical monitoring and food choice limitations may have increased the perception of the pathological condition, thereby increasing the sense of responsibility in adhering to the NT.

MO155: The Importance of Measured GFR in Clinical Practice: An Old Knowledge for Nephrologists, a New Challenge for Oncologists and Surgeons

BACKGROUND AND AIMS

In daily clinical practice, an accurate assessment of renal function is of paramount importance in several categories of patients where the adequate medical or surgical treatment depends on the values of glomerular filtration rate (GFR). In particular, both oncological and urological patients require a personalized medical approach able to avoid misleading errors which could dramatically shorten their lifespan. Unfortunately, the most used method to measure GFR in these groups of patients is represented by the estimated glomerular filtration rate (eGFR), which harbours a significant error in comparison to gold standards methods (mGFR). The aim of this study was to determine the extent of the error of eGFR compared to the mGFR in a consecutive prospective cohort of oncological patients affected by urological malignancies.

METHOD

A total consecutive cohort of 352 patients enrolled in a single tertiary institution between 2018 and 2021 was collected in order to compare the most common eGFR formulas used by physicians (Cockroft-Gault, MDRD, CKD-EPI based on serum creatinine and/or serum cystatin and the new eGFR equation based on creatinine and cystatin without race adjustment) with the most widespread mGFR method (Iohexol Plasma Clearance). The study cohort was composed by 188 oncological patients affected by different types of urological malignancies (cases) before surgical operation and/or medical treatment and 164 non-oncological patients (controls) matched for baseline clinical variables and GFR.

 The agreement between eGFR and mGFR was evaluated using bias (as median of difference), precision (as interquartile range of difference—IQR) accuracy (as P30) and total deviation index (TDI). The differences between cohorts were evaluated with Fisher's exact test and Chi-squared test for ordinal characteristics and Wilcoxon rank sum test for continuous variables. Data analysis was performed using programming language R and Python.

RESULTS

Clinical data were as follows: median age 68 (IQR: 20.68), M/F ratio 3.19, median BMI 24.9 (IQR: 0.003, 24.938). A total of 61.2% of patients had hypertension, and 14.3% were diabetics. The median creatinine value in the overall population was 1.48 mg/dL (IQR: 0.45, 1.48); the median cystatin value was 1.26 mg/dL (IQR: 0.42, 1.26). Based on iohexol plasma clearance, 3.13% of patients were classified in CKD stage 1, 23.30% in stage 2, 29.55% in stage 3a, 27.27% in stage 3b, 14.77% in stage 4 and 1.99% in stage 5. The two matched cohorts of oncological and non-oncological patients displayed no statistical differences in terms of clinical variables and agreement parameters (TDI, CCC and P30). Surprisingly, both groups harboured a non-negligible error in each CKD class with a huge discrepancy between the eGFR formulas and the gold standard method (Figures 1 and 2), suggesting the great relevance of mGFR in the clinical decision-making algorithm, both in oncological and in non-oncological patients.

CONCLUSION

We observed that the error in the classification of CKD stages using eGFR formulas was very common, both in oncological and in nephrological patients, with a poor agreement with mGFR in all CKD classes. Therefore, mGFR remains a crucial tool for a correct clinical decision in all onconephrological patients who require surgery or potential nephrotoxic agents.

Targeting Default Mode Network Dysfunction in Persons at Risk of Alzheimer's Disease with Transcranial Magnetic Stimulation (NEST4AD): Rationale and Study Design

BACKGROUND

Default mode network (DMN) dysfunction is well established in Alzheimer's disease (AD) and documented in both preclinical stages and at-risk subjects, thus representing a potential disease target. Multi-sessions of repetitive transcranial magnetic stimulation (rTMS) seem capable of modulating DMN dynamics and memory in healthy individuals and AD patients; however, the potential of this approach in at-risk subjects has yet to be tested.

OBJECTIVE

This study will test the effect of rTMS on the DMN in healthy older individuals carrying the strongest genetic risk factor for AD, the Apolipoprotein E (APOE) ɛ4 allele.

METHODS

We will recruit 64 older participants without cognitive deficits, 32 APOE ɛ4 allele carriers and 32 non-carriers as a reference group. Participants will undergo four rTMS sessions of active (high frequency) or sham DMN stimulation. Multimodal imaging exam (including structural, resting-state, and task functional MRI, and diffusion tensor imaging), TMS with concurrent electroencephalography (TMS-EEG), and cognitive assessment will be performed at baseline and after the stimulation sessions.

RESULTS

We will assess changes in DMN connectivity with resting-state functional MRI and TMS-EEG, as well as changes in memory performance in APOE ɛ4 carriers. We will also investigate the mechanisms underlying DMN modulation through the assessment of correlations with measures of neuronal activity, excitability, and structural connectivity with multimodal imaging.

CONCLUSION

The results of this study will inform on the physiological and cognitive outcomes of DMN stimulation in subjects at risk for AD and on the possible mechanisms. These results may outline the design of future non-pharmacological preventive interventions for AD.

Convergent and Discriminant Validity of Default Mode Network and Limbic Network Perfusion in Amnestic Mild Cognitive Impairment Patients

BACKGROUND

Previous studies reported default mode network (DMN) and limbic network (LIN) brain perfusion deficits in patients with amnestic mild cognitive impairment (aMCI), frequently a prodromal stage of Alzheimer's disease (AD). However, the validity of these measures as AD markers has not yet been tested using MRI arterial spin labeling (ASL).

OBJECTIVE

To investigate the convergent and discriminant validity of DMN and LIN perfusion in aMCI.

METHODS

We collected core AD markers (amyloid-β 42 [Aβ42], phosphorylated tau 181 levels in cerebrospinal fluid [CSF]), neurodegenerative (hippocampal volumes and CSF total tau), vascular (white matter hyperintensities), genetic (apolipoprotein E [APOE] status), and cognitive features (memory functioning on Paired Associate Learning test [PAL]) in 14 aMCI patients. Cerebral blood flow (CBF) was extracted from DMN and LIN using ASL and correlated with AD features to assess convergent validity. Discriminant validity was assessed carrying out the same analysis with AD-unrelated features, i.e., somatomotor and visual networks' perfusion, cerebellar volume, and processing speed.

RESULTS

Perfusion was reduced in the DMN (F = 5.486, p = 0.039) and LIN (F = 12.678, p = 0.004) in APOE ɛ4 carriers compared to non-carriers. LIN perfusion correlated with CSF Aβ42 levels (r = 0.678, p = 0.022) and memory impairment (PAL, number of errors, r = -0.779, p = 0.002). No significant correlation was detected with tau, neurodegeneration, and vascular features, nor with AD-unrelated features.

CONCLUSION

Our results support the validity of DMN and LIN ASL perfusion as AD markers in aMCI, indicating a significant correlation between CBF and amyloidosis, APOE ɛ4, and memory impairment.

Functional Imaging to Guide Network-Based TMS Treatments: Toward a Tailored Medicine Approach in Alzheimer's Disease

A growing number of studies is using fMRI-based connectivity to guide transcranial magnetic stimulation (TMS) target identification in both normal and clinical populations. TMS has gained increasing attention as a potential therapeutic strategy also in Alzheimer's disease (AD), but an endorsed target localization strategy in this population is still lacking. In this proof of concept study, we prove the feasibility of a tailored TMS targeting approach for AD, which stems from a network-based perspective. Based on functional imaging, the procedure allows to extract individual optimal targets meanwhile accounting for functional variability. Single-subject resting-state fMRI was used to extract individual target coordinates of two networks primarily affected in AD, the default mode and the fronto-parietal network. The localization of these targets was compared to that of traditional group-level approaches and tested against varying degrees of TMS focality. The distance between individual fMRI-derived coordinates and traditionally defined targets was significant for a supposed TMS focality of 12 mm and in some cases up to 20 mm. Comparison with anatomical labels confirmed a lack of 1:1 correspondence between anatomical and functional targets. The proposed network-based fMRI-guided TMS approach, while accounting for inter-individual functional variability, allows to target core AD networks, and might thus represent a step toward tailored TMS interventions for AD.

Trace elements in toenails in a population living near a modern municipal solid waste incinerator in Modena (Italy)

BACKGROUND AND OBJECTIVES

A cross-sectional biomonitoring study was performed in Modena (Italy) to assess trace element levels in toenails in a population living near a municipal solid waste incinerator (SWI), and investigate potential differences in their concentrations according to SWI emission exposure and other environmental and behavioral factors.

METHODS

During the winter 2013/14 eligible subjects, aged 18-69 yrs, living within 4 km from SWI, were randomly selected from the population register. Toxic and essential element concentrations (As, Cd, Cr, Cu, Mn, Ni, Pb, Se, Zn) were analyzed in 489 toenail samples. Individual exposure to SWI emissions was estimated by using, as a tracer, fall-out maps of emitted particulate matter. Information on anthropometric parameters, lifestyles, diet, and road traffic, residential and work exposures were collected by questionnaires and objective measurements. Multivariate logistic regression analyses were carried out, separately for females and males.

RESULTS

Excluding As, toxic elements were found, usually at low levels, in many samples, while essential elements, especially Cu and Zn, showed higher levels. Overall, no clear relationships between element levels and SWI exposure were observed, whereas associations with other environmental and lifestyle factors were found, including local food consumption, smoking and occupation.

CONCLUSIONS

The low pollutant concentrations measured in SWI emissions could explain the absence of clear patterns in toenail levels across SWI exposure levels. The associations observed with other factors suggest that, at least in this specific population, other environmental exposures and personal behaviors could act as more important predictors of trace element uptake.

Amygdalar nuclei and hippocampal subfields on MRI: Test-retest reliability of automated volumetry across different MRI sites and vendors

BACKGROUND

The amygdala and the hippocampus are two limbic structures that play a critical role in cognition and behavior, however their manual segmentation and that of their smaller nuclei/subfields in multicenter datasets is time consuming and difficult due to the low contrast of standard MRI. Here, we assessed the reliability of the automated segmentation of amygdalar nuclei and hippocampal subfields across sites and vendors using FreeSurfer in two independent cohorts of older and younger healthy adults.

METHODS

Sixty-five healthy older (cohort 1) and 68 younger subjects (cohort 2), from the PharmaCog and CoRR consortia, underwent repeated 3D-T1 MRI (interval 1-90 days). Segmentation was performed using FreeSurfer v6.0. Reliability was assessed using volume reproducibility error (ε) and spatial overlapping coefficient (DICE) between test and retest session.

RESULTS

Significant MRI site and vendor effects (p ​< ​.05) were found in a few subfields/nuclei for the ε, while extensive effects were found for the DICE score of most subfields/nuclei. Reliability was strongly influenced by volume, as ε correlated negatively and DICE correlated positively with volume size of structures (absolute value of Spearman's r correlations >0.43, p ​< ​1.39E-36). In particular, volumes larger than 200 ​mm³ (for amygdalar nuclei) and 300 ​mm³ (for hippocampal subfields, except for molecular layer) had the best test-retest reproducibility (ε ​< ​5% and DICE ​> ​0.80).

CONCLUSION

Our results support the use of volumetric measures of larger amygdalar nuclei and hippocampal subfields in multisite MRI studies. These measures could be useful for disease tracking and assessment of efficacy in drug trials.

Whole-brain microstructural white matter alterations in borderline personality disorder patients

BACKGROUND

Borderline personality disorder (BPD) is a psychiatric condition associated with the impairment of the frontolimbic network. However, a growing body of studies suggests that brain dysfunction underling BPD could involve other brain areas. We explored the whole-brain white matter (WM) organization in BPD patients to clarify the structural pattern underlying the disease and its relationship with clinical features.

METHODS

Fourteen BPD patients and 14 healthy controls underwent a multidimensional clinical assessment and diffusion tensor imaging acquisition. Measures of fractional anisotropy (FA) and mean, axial and radial (RD) diffusivity were collected, and alterations in the WM were assessed using the voxelwise approach, including substance and alcohol abuse as covariates. Voxelwise regression analysis was performed to identify associations between microstructural changes and clinical feature in BPD.

RESULTS

Group comparisons showed alterations only for FA and RD: FA decreased in the right posterior hemisphere, while RD increased bilaterally and widespread in anterior and posterior areas (p < 0.05, threshold-free cluster enhancement corrected). Moreover, WM alterations of the corpus callosum were related to anxiety in BPD group.

DISCUSSION

Our data support the idea that structural alterations underling BPD also involve cortico-cortical pathways, corticothalamic and corticostriatal tracts, suggesting that the frontolimbic model should be reinterpreted. © 2019 John Wiley & Sons, Ltd.

Abnormalities in functional connectivity in borderline personality disorder: Correlations with metacognition and emotion dysregulation

A few studies reported functional abnormalities at rest in borderline personality disorder (BPD), but their relationship with clinical aspect is unclear. We aimed to assess functional connectivity (FC) in BPD patients and its association with BPD clinical features. Twenty-one BPD patients and 14 healthy controls (HC) underwent a multidimensional assessment and resting-state fMRI. Independent component analysis was performed to identify three resting-state networks: default mode network (DMN), salience network (SN), and executive control network (ECN). FC differences between BPD and HC were assessed with voxel-wise two-sample t-tests. Additionally, we investigated the mean FC within each network and the relationship between connectivity measures and BPD clinical features. Patients showed significant lower mean FC in the DMN and SN, while, at the local level, a cluster of lower functional connectivity emerged in the posterior cingulate cortex of the DMN. The DMN connectivity was positively correlated with the anger-state intensity and expression, while the SN connectivity was positively correlated with metacognitive abilities and a negative correlation emerged with the interpersonal aggression. The dysfunctional connectivity within these networks might explain clinical features of BPD patients.

ETS Exposure and PAH Body Burden in Nonsmoking Italian Adults

Active smoking is associated with increased body burden of polycyclic aromatic hydrocarbons (PAHs); the aim of this study was to assess whether environmental tobacco smoking (ETS) increases the internal dose of PAHs. In 344 nonsmoking Italian adults, out of 497 individuals selected as representative of the population of the town of Modena, ETS exposure was evaluated by a self-administered questionnaire and by the measurement of urinary cotinine (COT-U). PAH exposure was assessed by the measurement of urinary 1-hydroxypyrene (1-OHPYR) and of ten urinary PAHs. In all subjects, median (5th⁻95th percentile) COT-U was 0.47 (.

Human biomonitoring of polycyclic aromatic hydrocarbonsand metals in the general population residing near the municipal solid waste incinerator of Modena, Italy

BACKGROUND AND OBJECTIVES

A cross-sectional biomonitoring study was carried out to investigate exposure to incinerator emission in relation to the body burden of selected biomarkers in the population living around the plant.

METHODS

Approximately 500 people, aged 18-69 yrs, living within 4 km from the incinerator were randomly selected form the population register. Exposure was measured through fall-out maps of particulate matter (PM), used as tracer for incinerator emissions. Ten metabolized polycyclic aromatic hydrocarbons (PAHs), from naphthalene to chrysene, 1-hydroxypyrene and twelve metals (Cd, Cr, Cu, Hg, Ni, Pb, Ni, Zn, V, Tl, As, Sn) were measured in spot urine samples. Confounders, such as diet, smoking, traffic, occupation and personal characteristics were assessed by questionnaires and objective measurements, and included into multivariate linear regression models.

RESULTS

Metal concentrations in urine were in line with or higher than Italian reference limits, besides Cr and V with more than twofold concentrations. Metal levels did not show clear association to exposure categories. Most abundant PAHs were naphthalene (median 26.2 ng/L) and phenanthrene (7.4 ng/L). All PAHs, but benz[a]anthracene and 1-hydroxypyrene, were found in more than 52% of samples, and included in regression models. Significant associations between urinary PAHs and exposure were found, strong for fluorene, and weaker for naphthalene, fluoranthene and pyrene. Results were confirmed by sensitivity analyses. Correlation with variables reported in literature were observed.

CONCLUSIONS

The study indicates that the emissions were very low and highlights that specific urinary PAHs provided useful information about the internal dose arising from incinerator emission.