How severity and classification of pulmonary hypertension affect pregnancy outcomes: a systematic review and timeline

Women with pulmonary hypertension (PH) have increased mortality during pregnancy and the peripartum period. An increasing number of publications suggest improvements in maternal outcomes, so we conducted a systematic review focusing on disease severity and maternal survival. After screening 9097 potential studies from 1967 to 2021, we identified 66 relevant publications. Outcomes improved continuously over time and mortality fell from 11.6% in studies published before 2015 to 8.2% in studies published after 2015. Mortality was lower in patients with mild disease (0.8%) than in those with Eisenmenger syndrome (26.2%) or idiopathic pulmonary arterial hypertension (7.4-24.0%). One major drawback of the published studies is that they define severity using echocardiographic-estimated pulmonary artery pressures, without considering more contemporary parameters. This systematic review provides new insights for preconception counseling on pregnancy risks related to PH and suggests that PH classification and severity should be carefully considered in determining an individual's pregnancy-associated risk.

Anabolic implants alter abundance of mRNA involved in muscle growth, metabolism, and inflammation in the longissimus of Angus steers in the feedlot

The majority of beef cattle in the United States often receive at least one anabolic implant resulting in improved growth, feed efficiency, and environmental and economic sustainability. However, the physiological and molecular mechanisms through which anabolic implants increase skeletal muscle growth of beef cattle remain elusive. The objective of this study was to identify transcriptional changes occurring in skeletal muscle of steers receiving anabolic implants containing different steroid hormones. Forty-eight steers were stratified by weight into 1 of 4 (n = 12/treatment) implant treatment groups: (1) estradiol (ImpE2; 25.7 mg E2; Compudose, Elanco Animal Health, Greenfield, IN), (2) trenbolone acetate (ImpTBA; 200 mg TBA; Finaplix-H, Merck Animal Health, Madison, NJ), (3) combination (ImpETBA; 120 mg TBA + 24 mg E2; Revalor-S, Merck Animal Health), or (4) no implant (CON). Skeletal muscle biopsies were taken from the longissimus 2 and 10 d post-implantation. The mRNA abundance of 94 genes associated with skeletal muscle growth was examined. At 10 d post-implantation, steers receiving ImpETBA had greater (P = 0.02) myoblast differentiation factor 1 transcript abundance than CON. Citrate synthase abundance was increased (P = 0.04) in ImpETBA steers compared to CON steers. In ImpE2 steers 10 d post-implantation, muscle RING finger protein 1 decreased (P = 0.05) compared to CON steers, and forkhead box protein O4 decreased (P = 0.05) in ImpETBA steers compared to CON steers. Interleukin-6 abundance tended to be increased (P = 0.09) in ImpE2 steers compared to both ImpETBA and CON steers. Furthermore, interleukin-10 mRNA abundance tended to be increased (P = 0.06) in ImpTBA steers compared to ImpETBA steers. Leptin receptor abundance was reduced (P = 0.01) in both ImpE2 and ImpTBA steers when compared to CON steers. Abundance of phosphodiesterase 4B was increased (P = 0.04) in ImpTBA steers compared to CON steers 2 d post-implantation. Taken together, the results of this research demonstrate that estradiol increases skeletal muscle growth via pathways related to nutrient partitioning and mitochondria function, while trenbolone acetate improves steer skeletal muscle growth via pathways related to muscle growth.

Learning Curve for Flow Diversion of Posterior Circulation Aneurysms: A Long-Term International Multicenter Cohort Study

BACKGROUND AND PURPOSE

Flow diversion has gradually become a standard treatment for intracranial aneurysms of the anterior circulation. Recently, the off-label use of the flow diverters to treat posterior circulation aneurysms has also increased despite initial concerns of rupture and the suboptimal results. This study aimed to explore the change in complication rates and treatment outcomes across time for posterior circulation aneurysms treated using flow diversion and to further evaluate the mechanisms and variables that could potentially explain the change and outcomes.

MATERIALS AND METHODS

A retrospective review using a standardized data set at multiple international academic institutions was performed to identify patients with ruptured and unruptured posterior circulation aneurysms treated with flow diversion during a decade spanning January 2011 to January 2020. This period was then categorized into 4 intervals.

RESULTS

A total of 378 procedures were performed during the study period. Across time, there was an increasing tendency to treat more vertebral artery and fewer large vertebrobasilar aneurysms (P = .05). Moreover, interventionalists have been increasingly using fewer overlapping flow diverters per aneurysm (P = .07). There was a trend toward a decrease in the rate of thromboembolic complications from 15.8% in 2011-13 to 8.9% in 2018-19 (P = .34).

CONCLUSIONS

This multicenter experience revealed a trend toward treating fewer basilar aneurysms, smaller aneurysms, and increased usage of a single flow diverter, leading to a decrease in the rate of thromboembolic and hemorrhagic complications.

157 WHOLE HIPPOCAMPAL VOLUMES AND HIPPOCAMPAL SUBFIELD VOLUMES IN MCI-LB AND MCI-ad

Background

Mild cognitive impairment with Lewy bodies (MCI-LB) is the commonest prodromal phenotype of Dementia with Lewy Bodies (DLB) and may be challenging to differentiate from MCI due to Alzheimer’s disease (MCI-AD). Preservation of medial temporal lobe structures on MRI is recognised as a supportive biomarker consistent with underlying Lewy body disease rather Alzheimer’s disease (AD).

We investigated whether whole hippocampal volume and differing hippocampal subfield atrophy patterns, could be used as a surrogate biomarker of underlying ad pathology, allowing for differentiation of MCI-LB from MCI-AD.

Methods

Participants were recruited to the following groups’: healthy controls (HC), MCI-LB and MCI-ad, all ≥60 years. Alongside detailed clinical, neuropsychological assessments, all participants underwent 3 T MRI, 123I-FP-CIT SPECT and 123I-MIBG myocardial scintigraphy. Using Freesurfer (v.6.0), a fully automated hippocampal subfield segmentation of the MRI data was performed.

Results

Groups consisted of 31 HC (mean age, 73.7 yrs; mean Mini-Mental state Examination [MMSE] score, 28.4), 34 MCI-LB (mean age, 74.7 yrs; mean MMSE score, 26.6) and 29 MCI-ad (mean age, 75.4 yrs; mean MMSE score, 27.1).

There was no significant difference in whole hippocampal volume between MCI-LB and MCI-ad(Mean (SD) in mm3: MCI-LB 6025 (961) vs MCI-ad 5407 (882), p = 0.12) or between MCI-LB and HC (Mean (SD) in mm3: MCI-LB 6025 (961) vs HC 6355 (962), p = 0.11). Whole hippocampal volume was significantly smaller in MCI-ad compared with HC (p < 0.001).

Comparison between MCI-LB and MCI-ad, showed absolute hippocampal subfield volumes were all lower in MCI-ad. However, the magnitude of the differences were small and no significant difference in hippocampal subfield volumes were noted between these groups, with the exception of the hippocampal tail being significantly smaller in MCI-ad compared to MCI-LB (p = 0.04).

Conclusion

In a well-characterised cohort, whole hippocampal and hippocampal subfield volumes were similarly atrophied in MCI-LB and MCI-ad and did not distinguish between the groups.

Cardiac 123I-MIBG normal uptake values are population-specific: Results from a cohort of controls over 60 years of age

PURPOSE

Cardiac 123I-MIBG image interpretation is affected by population differences and technical factors. We recruited older adults without cognitive decline and compared their cardiac MIBG uptake with results from the literature.

METHODS

Phantom calibration confirmed that cardiac uptake results from Japan could be applied to our center. We recruited 31 controls, 17 individuals with dementia with Lewy bodies (DLB) and 15 with Alzheimer's disease (AD). Images were acquired 20 minutes and four hours after injection using Siemens cameras with medium-energy low-penetration (MELP) collimators. Local normal heart-to-mediastinum (HMR) ratios were compared to Japanese results.

RESULTS

Siemens gamma cameras with MELP collimators should give HMRs very close to the calibrated values used in Japan. However, our cut-offs with controls were lower at 2.07 for early and 1.86 for delayed images. Applying our lower cut-off to the dementia patients may increase the specificity of cardiac MIBG imaging for DLB diagnosis in a UK population without reducing sensitivity.

CONCLUSIONS

Our local HMR cut-off values are lower than in Japan, higher than in a large US study but similar to those found in another UK center. UK centers using other cameras and collimators may need to use different cut-offs to apply our results.

Concomitant LATE-NC in Alzheimer's disease is not associated with increased tau or amyloid-β pathological burden

AIMS

Limbic-predominant age-related TDP-43 encephalopathy neuropathological change (LATE-NC) is present in approximately 50% of Alzheimer's disease (AD) cases and is associated with accelerated cognitive decline. Studies indicate a potential synergistic relationship between LATE-NC and hyperphosphorylated tau. It is unknown if LATE-NC is an independent driver of cognitive impairment or exerts its influence through synergistic relationships with tau. This cliniconeuropathological study investigated the impact of LATE-NC on quantified measures of AD-associated pathology and its impact on clinical measures.

METHODS

A total of 61 AD cases underwent neuropathological assessment for LATE-NC and quantitative assessment [area covered by immunoreactivity (IR)] for early conformational tau (MC-1), late-stage hyperphosphorylated tau (AT8) and amyloid-β in the amygdala and five neocortical regions. Clinical measures included age of disease onset, final Mini-Mental State Examination (MMSE) score and rate of cognitive decline.

RESULTS

LATE-NC was present in 41 AD cases (AD/LATE-NC; 67.2%). No significant differences in MC-1-IR, AT8-IR or 4G8-IR were observed in any region between AD/LATE-NC and AD without LATE-NC, indicating no accelerated aggregation or hyperphosphorylation of tau proteins in the AD/LATE-NC cases. Final MMSE was significantly lower in AD/LATE-NC cases and was significantly associated with LATE-NC score even when controlled for the presence of both MC-1-IR and AT8-IR (P = 0.009).

CONCLUSION

The presence of LATE-NC in AD is not associated with an increase in the burden of early or late tau or Aβ pathology. LATE-NC is associated with a lower final MMSE score independent of tau pathology.

Failure of standard tracheostomy decannulation criteria to detect suprastomal pathology

Meeting established criteria for tracheostomy decannulation should improve success, although there will be a small proportion of patients with a tracheostomy who fail decannulation. Failure rates depend on patient characteristics and disparity between institutional practices and expert opinion. However, there are no widely accepted published failure rates, or agreement on the time-point at which failure is assessed. We present a patient who had evidence of readiness for decannulation, but had immediate failure due to extrinsic tracheal compression, which proved difficult to diagnose and required surgery to resolve. Capping the tracheostomy before decannulation may or may not have given rise to suspicion of potential failure and this practice requires further evaluation as it is not without risk. For subglottic, but suprastomal lesions, nasendoscopy is not of value. It is important to decannulate patients in a safe environment, preferably early in the day to allow post decannulation observations and interventions should they become necessary, and with the close involvement of the multi-professional team. This report illustrates the failure of our standard Tracheostomy decannulation criteria, and direct upper airway view to identify suprastomal tracheal pathology, and we discuss the potential for additional criteria which may have identified the issue before decannulation attempts.

Multicenter Postmarket Analysis of the Neuroform Atlas Stent for Stent-Assisted Coil Embolization of Intracranial Aneurysms

BACKGROUND AND PURPOSE

The Neuroform Atlas is a new microstent to assist coil embolization of intracranial aneurysms that recently gained FDA approval. We present a postmarket multicenter analysis of the Neuroform Atlas stent.

MATERIALS AND METHODS

On the basis of retrospective chart review from 11 academic centers, we analyzed patients treated with the Neuroform Atlas after FDA exemption from January 2018 to June 2019. Clinical and radiologic parameters included patient demographics, aneurysm characteristics, stent parameters, complications, and outcomes at discharge and last follow-up.

RESULTS

Overall, 128 aneurysms in 128 patients (median age, 62 years) were treated with 138 stents. Risk factors included smoking (59.4%), multiple aneurysms (27.3%), and family history of aneurysms (16.4%). Most patients were treated electively (93.7%), and 8 (6.3%) underwent treatment within 2 weeks of subarachnoid hemorrhage. Previous aneurysm treatment failure was present in 21% of cases. Wide-neck aneurysms (80.5%), small aneurysm size (<7 mm, 76.6%), and bifurcation aneurysm location (basilar apex, 28.9%; anterior communicating artery, 27.3%; and middle cerebral artery bifurcation, 12.5%) were common. A single stent was used in 92.2% of cases, and a single catheter for both stent placement and coiling was used in 59.4% of cases. Technical complications during stent deployment occurred in 4.7% of cases; symptomatic thromboembolic stroke, in 2.3%; and symptomatic hemorrhage, in 0.8%. Favorable Raymond grades (Raymond-Roy occlusion classification) I and II were achieved in 82.9% at discharge and 89.5% at last follow-up. mRS ≤2 was determined in 96.9% of patients at last follow-up. The immediate Raymond-Roy occlusion classification grade correlated with aneurysm location (P < .0001) and rupture status during treatment (P = .03).

CONCLUSIONS

This multicenter analysis provides a real-world safety and efficacy profile for the treatment of intracranial aneurysms with the Neuroform Atlas stent.

Implications of the Collar Sign in Incompletely Occluded Aneurysms after Pipeline Embolization Device Implantation: A Follow-Up Study

BACKGROUND AND PURPOSE

The angiographic collar sign has been recently described in patients with incompletely occluded aneurysms after Pipeline Embolization Device implantation. The long-term implications of this sign are unknown. We report angiographic outcomes of patients with the collar sign with follow-up of up to 45 months and the implications of this angiographic finding.

MATERIALS AND METHODS

We performed a retrospective review of a prospectively maintained data base of patients who underwent Pipeline Embolization Device implantation for an intracranial aneurysm at our institution between January 2014 and December 2016. We included patients with a collar sign at the initial follow-up angiogram after Pipeline Embolization Device implantation.

RESULTS

A total of 198 patients with 285 aneurysms were screened for the collar sign on initial and subsequent follow-up angiograms. There were 226 aneurysms (79.3%) with complete occlusion at the first follow-up. Of 59 incompletely occluded aneurysms, 19 (32.2%) aneurysms in 17 patients were found to have a collar sign on the first angiographic follow-up (median, 6 months; range, 4.2-7.2). Ten (52.6%) aneurysms underwent retreatment with a second Pipeline Embolization Device, which resulted in aneurysm occlusion in 1 (10%) patient. There were only 3 (15.8%) aneurysms with complete occlusion at the last follow-up, 2 (10.5%) of which had a single Pipeline Embolization Device implantation and another single (5.3%) aneurysm with a second Pipeline Embolization Device implantation.

CONCLUSIONS

A collar sign on the initial angiogram after Pipeline Embolization Device placement is a predictor of poor aneurysm occlusion. Because the occlusion rates remain equally low regardless of retreatment in patients with a collar sign, radiologic follow-up may be more appropriate than retreatment.

Ideology Matters: College Students’ Emotional Reactions to the Killing of Trayvon Martin

Building on previous theory and research, we explored the associations among race, intergroup ideologies and emotional reactions to the killing of Trayvon Martin and the acquittal of George Zimmerman among 298 Black and White college students. We also examined the indirect effect of ethnocultural empathy on the links between race, intergroup ideologies, and emotional responding. Using latent class analysis, we identified three latent intergroup ideological classes: Racial Hierarchy-Enhancing Ideology, Universal Hierarchy-Enhancing Ideology (i.e., above sample mean color-blind racial ideology and or social dominance orientation) and Critical Reflection Attenuating Ideology (i.e., above sample mean critical consciousness). Membership in the Critical Reflection Attenuating Ideology group was associated with greater prosocial emotional responding as compared to the two hierarchy-enhancing latent groups. Finally, ethnocultural empathy had an indirect effect on the links between race, latent intergroup ideological classes, and emotional responding.

Validating a risk stratification tool for audit of early outcome after operations for squamous cell carcinoma of the head and neck

The aim of this study was to validate a case-mix adjustment tool (neural network) for the audit of postoperative outcomes. We tested its calibration and discrimination on two unseen groups of patients being treated for squamous cell carcinoma (SCC) of the head and neck and compared observed complication rates with predicted rates. A total of 196 patients who were treated at two UK NHS institutions between 2016 and 2018 were audited. Preoperative data pertaining to risk (T classification, complexity of operation, and "high-risk" status) were collected, together with data on postoperative complications. Diagnostic test statistics and receiver operating curves (ROC) were used to test the performance of the tool. The score was well calibrated (predicted and observed complication rates both 43%), but discrimination suggested only fair accuracy (ROC 0.66 - 0.68). Adjustment of case mix for the audit of postoperative complications is difficult, although our model suggests that departmental audit is possible, and its accuracy is equivalent to that of other national audits. Further work may elucidate key variables that have not yet been assessed.

Alzheimer's disease polygenic risk score as a predictor of conversion from mild-cognitive impairment

Mild-cognitive impairment (MCI) occurs in up to one-fifth of individuals over the age of 65, with approximately a third of MCI individuals converting to dementia in later life. There is a growing necessity for early identification for those at risk of dementia as pathological processes begin decades before onset of symptoms. A cohort of 122 individuals diagnosed with MCI and followed up for a 36-month period for conversion to late-onset Alzheimer's disease (LOAD) were genotyped on the NeuroChip array along with pathologically confirmed cases of LOAD and cognitively normal controls. Polygenic risk scores (PRS) for each individual were generated using PRSice-2, derived from summary statistics produced from the International Genomics of Alzheimer's Disease Project (IGAP) genome-wide association study. Predictability models for LOAD were developed incorporating the PRS with APOE SNPs (rs7412 and rs429358), age and gender. This model was subsequently applied to the MCI cohort to determine whether it could be used to predict conversion from MCI to LOAD. The PRS model for LOAD using area under the precision-recall curve (AUPRC) calculated a predictability for LOAD of 82.5%. When applied to the MCI cohort predictability for conversion from MCI to LOAD was 61.0%. Increases in average PRS scores across diagnosis group were observed with one-way ANOVA suggesting significant differences in PRS between the groups (p < 0.0001). This analysis suggests that the PRS model for LOAD can be used to identify individuals with MCI at risk of conversion to LOAD.

On Flow Diversion: The Changing Landscape of Intracerebral Aneurysm Management

Uptake of flow-diverting technology is rapidly outpacing the availability of clinical evidence. Most current usage is off-label, and the endovascular community is nearer the beginning than the end of the learning curve, given the number of devices in development. A comprehensive overview of technical specifications alongside key outcome data is essential both for clinical decision-making and to direct further investigations. Most-studied has been the Pipeline Embolization Device, which has undergone a transition to the Pipeline Flex for which outcome data are sparse or heterogeneous. Alternative endoluminal devices do not appear to be outperforming the Pipeline Embolization Device to date, though prospective studies and long-term data mostly are lacking, and between-study comparisons must be treated with caution. Nominal technical specifications may be unrelated to in situ performance, emphasizing the importance of correct radiologic sizing and device placement. Devices designed specifically for bifurcation aneurysms also lack long-term outcome data or have only recently become available for clinical use. There are no major studies directly comparing a flow-diverting device with standard coiling or microsurgical clipping. Data on flow-diverting stents are too limited in terms of long-term outcomes to reliably inform clinical decision-making. The best available evidence supports using a single endoluminal device for most indications. Recommendations on the suitability and choice of a device for bifurcation or ruptured aneurysms or for anatomically complex lesions cannot be made on the basis of current evidence. The appropriateness of flow-diverting treatment must be decided on a case-by-case basis, considering experience and the relative risks against standard approaches or observation.

Endothelialization following Flow Diversion for Intracranial Aneurysms: A Systematic Review

BACKGROUND

The underlying mechanism of action of flow diverters is believed to be the induction of aneurysm thrombosis and simultaneous endothelial cell growth along the device struts, thereby facilitating aneurysm exclusion from the circulation. Although extensive attention has been paid to the role of altered cerebrovascular hemodynamics using computational fluid dynamics analyses, relatively less emphasis has been placed on the role of the vascular endothelium in promoting aneurysm healing.

PURPOSE

Our aim was to systematically review all available literature investigating the mechanism of action of flow diverters in both human patients and preclinical models.

DATA SOURCES

A systematic search of PubMed, Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, and the Web of Science electronic data bases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

STUDY SELECTION

We selected articles assessing the role of endothelialization in flow-diverter treatment of cerebral aneurysms, including both preclinical and clinical studies.

DATA ANALYSIS

Ten articles were eligible for inclusion in this review. Two assessed endothelialization in human patients, while the other 8 used preclinical models (either rabbits or pigs).

DATA SYNTHESIS

Methods used to assess endothelialization included optical coherence tomography and scanning electron microscopy.

LIMITATIONS

A limitation was the heterogeneity of studies.

CONCLUSIONS

Current data regarding the temporal relationship to flow-diverter placement has largely been derived from work in preclinical animal models. Whether these cells along the device struts originate from adjacent endothelial cells or are the result of homing of circulating endothelial progenitor cells is equivocal.

Risk of Branch Occlusion and Ischemic Complications with the Pipeline Embolization Device in the Treatment of Posterior Circulation Aneurysms

BACKGROUND AND PURPOSE

Flow diversion with the Pipeline Embolization Device is increasingly used for endovascular treatment of intracranial aneurysms due to high reported obliteration rates and low associated morbidity. While obliteration of covered branches in the anterior circulation is generally asymptomatic, this has not been studied within the posterior circulation. The aim of this study was to evaluate the association between branch coverage and occlusion, as well as associated ischemic events in a cohort of patients with posterior circulation aneurysms treated with the Pipeline Embolization Device.

MATERIALS AND METHODS

A retrospective review of prospectively maintained databases at 8 academic institutions from 2009 to 2016 was performed to identify patients with posterior circulation aneurysms treated with the Pipeline Embolization Device. Branch coverage following placement was evaluated, including the posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery, and posterior cerebral artery. If the Pipeline Embolization Device crossed the ostia of the contralateral vertebral artery, its long-term patency was assessed as well.

RESULTS

A cohort of 129 consecutive patients underwent treatment of 131 posterior circulation aneurysms with the Pipeline Embolization Device. Adjunctive coiling was used in 40 (31.0%) procedures. One or more branches were covered in 103 (79.8%) procedures. At a median follow-up of 11 months, 11% were occluded, most frequently the vertebral artery (34.8%). Branch obliteration was most common among asymptomatic aneurysms (P < .001). Ischemic complications occurred in 29 (22.5%) procedures. On multivariable analysis, there was no significant difference in ischemic complications in cases in which a branch was covered (P = .24) or occluded (P = .16).

CONCLUSIONS

There was a low occlusion incidence in end arteries following branch coverage at last follow-up. The incidence was higher in the posterior cerebral artery and vertebral artery where collateral supply is high. Branch occlusion was not associated with a significant increase in ischemic complications.

Predictors of Incomplete Occlusion following Pipeline Embolization of Intracranial Aneurysms: Is It Less Effective in Older Patients?

BACKGROUND AND PURPOSE

Flow diversion with the Pipeline Embolization Device (PED) for the treatment of intracranial aneurysms is associated with a high rate of aneurysm occlusion. However, clinical and radiographic predictors of incomplete aneurysm occlusion are poorly defined. In this study, predictors of incomplete occlusion at last angiographic follow-up after PED treatment were assessed.

MATERIALS AND METHODS

A retrospective analysis of consecutive aneurysms treated with the PED between 2009 and 2016, at 3 academic institutions in the United States, was performed. Cases with angiographic follow-up were selected to evaluate factors predictive of incomplete aneurysm occlusion at last follow-up.

RESULTS

We identified 465 aneurysms treated with the PED; 380 (81.7%) aneurysms (329 procedures; median age, 58 years; female/male ratio, 4.8:1) had angiographic follow-up, and were included. Complete occlusion (100%) was achieved in 78.2% of aneurysms. Near-complete (90%-99%) and partial (<90%) occlusion were collectively achieved in 21.8% of aneurysms and defined as incomplete occlusion. Of aneurysms followed for at least 12 months (211 of 380), complete occlusion was achieved in 83.9%. Older age (older than 70 years), nonsmoking status, aneurysm location within the posterior communicating artery or posterior circulation, greater aneurysm maximal diameter (≥21 mm), and shorter follow-up time (<12 months) were significantly associated with incomplete aneurysm occlusion at last angiographic follow-up on univariable analysis. However, on multivariable logistic regression, only age, smoking status, and duration of follow-up were independently associated with occlusion status.

CONCLUSIONS

Complete occlusion following PED treatment of intracranial aneurysms can be influenced by several factors related to the patient, aneurysm, and treatment. Of these factors, older age (older than 70 years) and nonsmoking status were independent predictors of incomplete occlusion. While the physiologic explanation for these findings remains unknown, identification of factors predictive of incomplete aneurysm occlusion following PED placement can assist in patient selection and counseling and might provide insight into the biologic factors affecting endothelialization.

Common and distinct patterns of grey-matter volume alteration in major depression and bipolar disorder: evidence from voxel-based meta-analysis

Finding robust brain substrates of mood disorders is an important target for research. The degree to which major depression (MDD) and bipolar disorder (BD) are associated with common and/or distinct patterns of volumetric changes is nevertheless unclear. Furthermore, the extant literature is heterogeneous with respect to the nature of these changes. We report a meta-analysis of voxel-based morphometry (VBM) studies in MDD and BD. We identified studies published up to January 2015 that compared grey matter in MDD (50 data sets including 4101 individuals) and BD (36 data sets including 2407 individuals) using whole-brain VBM. We used statistical maps from the studies included where available and reported peak coordinates otherwise. Group comparisons and conjunction analyses identified regions in which the disorders showed common and distinct patterns of volumetric alteration. Both disorders were associated with lower grey-matter volume relative to healthy individuals in a number of areas. Conjunction analysis showed smaller volumes in both disorders in clusters in the dorsomedial and ventromedial prefrontal cortex, including the anterior cingulate cortex and bilateral insula. Group comparisons indicated that findings of smaller grey-matter volumes relative to controls in the right dorsolateral prefrontal cortex and left hippocampus, along with cerebellar, temporal and parietal regions were more substantial in major depression. These results suggest that MDD and BD are characterised by both common and distinct patterns of grey-matter volume changes. This combination of differences and similarities has the potential to inform the development of diagnostic biomarkers for these conditions.

Treatment of Tandem Internal Carotid Artery Aneurysms Using a Single Pipeline Embolization Device: Evaluation of Safety and Efficacy

BACKGROUND AND PURPOSE

Tandem aneurysms are defined as multiple aneurysms located in close proximity on the same parent vessel. Endovascular treatment of these aneurysms has rarely been reported. Our aim was to evaluate the safety and efficacy of a single Pipeline Embolization Device for the treatment of tandem aneurysms of the internal carotid artery.

MATERIALS AND METHODS

A retrospective analysis of consecutive aneurysms treated with the Pipeline Embolization Device between 2009 and 2016 at 3 institutions in the United States was performed. Cases included aneurysms of the ICA treated with a single Pipeline Embolization Device, and they were divided into tandem versus solitary. Angiographic and clinical outcomes were compared.

RESULTS

The solitary group (median age, 58 years) underwent 184 Pipeline Embolization Device procedures for 184 aneurysms. The tandem group (median age, 50.5 years) underwent 34 procedures for 78 aneurysms. Aneurysms were primarily located along the paraophthalmic segment of the ICA in both the single and tandem groups (72.3% versus 78.2%, respectively, P = .53). The median maximal diameters in the solitary and tandem groups were 6.2 and 6.7 mm, respectively. Complete occlusion on the last angiographic follow-up was achieved in 75.1% of aneurysms in the single compared with 88.6%% in the tandem group (P = .06). Symptomatic thromboembolic complications were encountered in 2.7% and 8.8% of procedures in the single and tandem groups, respectively (P = .08).

CONCLUSIONS

Tandem aneurysms of the ICA can be treated with a single Pipeline Embolization Device with high rates of complete occlusion. While there appeared to be a trend toward higher thromboembolic complication rates, this did not reach statistical significance.

Abstract P3-07-11: Inhibition of Pin1 or CDK-mediated Smad3 phosphorylation reduces triple negative breast cancer cell EMT, migration and invasion

Introduction: Triple negative breast cancer (TNBC) is an aggressive subtype associated with poor outcomes. Accordingly, there is an urgent need to develop novel and targeted therapeutics for patients with this disease subtype. Cyclins D and E and the corresponding activation of CDK4/2 represent promising therapeutic targets for the treatment of TNBC. CDK4/2 can non-canonically phosphorylate Smad3, a key TGFβ signaling intermediate, and this phosphorylation is associated with the promotion of cell migration and EMT in cyclin-overexpressing breast cancers. Additionally, CDK-mediated Smad3 phosphorylation facilitates an interaction between Smad3 and Pin1. Pin1 is a cis-trans isomerase that is also overexpressed in aggressive breast cancers and can enable TNBC cell migration. Based on these findings, we hypothesized that blockade of the CDK-mediated Smad3-Pin1 interaction, either through inhibition of Pin1 or CDK-mediated Smad3 phosphorylation, would abrogate TNBC cell migration and invasion.

Methods: Pin1 expression was knocked-down (KD) in MDA-MB-231, MDA-MB-436, and Hs578T TNBC cells by transfection with Pin1-targeting siRNA (siPin1) or control non-specific siRNA (siNS). KD efficiency was confirmed with immunoblotting. Pin KD/TNBC cell migration and invasion assays were performed on uncoated or Matrigel-coated trans-wells, respectively. Media containing 10% FBS was used as a chemoattractant. Following Pin1 KD, immunoblotting was used to evaluate EMT-associated protein expression. To inhibit CDK-mediated Smad3 phosphorylation, TNBC cells were treated with 600 nM of CDK2 inhibitor (CDK2i) for 72 hours. Immunoblotting was then performed to determine Smad3 phosphorylation and EMT-associated protein expression. Co-immunoprecipitation assays were used to examine the impact of CDK2i treatment on the Smad3-Pin1 interaction. Finally, following CDK2i treatment, assays were performed to determine the ability of TNBC cells to migrate and invade.

Results: KD of Pin1 expression in TNBC cells resulted in a decrease in cell migration and invasion when compared to control cells in all the study cell lines. This corresponded with changes in EMT-associated protein expression, including increased levels of ZO-1 and claudin and decreased β-catenin. CDK2i treatment produced a decrease in Smad3 T179 site non-canonical phosphorylation and inhibited Smad3-Pin1 binding. CDK2i treatment also abrogated TNBC cell migration and invasion, paralleling expression changes in EMT-associated proteins with an increase in claudin and decrease in β-catenin.

Conclusions: Inhibition of the Smad3-Pin1 interaction, through KD of Pin1 expression or CDK2i-mediated blockade of non-canonical Smad3 phosphorylation, reduced TNBC cell EMT-type changes, demonstrated by increased expression of the tight junction proteins ZO-1 and claudin and decreased β-catenin, a key player in the WNT pathway. These findings also correlated to a reduction in TNBC cell migration and invasion. Collectively, these data show that the Smad3-Pin1 interaction, facilitated by CDK-mediated Smad3 phosphorylation, is associated with pro-migratory TGFβ signaling. Inhibition of this interaction, with CDK2 inhibitor treatment, may provide an important therapeutic option for TNBC patients.

Citation Format: Thomas AL, Hamdan R, Hong A, Lind H, Oppat K, Rosenthal E, Thomas AJ, Jeruss JS. Inhibition of Pin1 or CDK-mediated Smad3 phosphorylation reduces triple negative breast cancer cell EMT, migration and invasion [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-07-11.

Collar Sign in Incompletely Occluded Aneurysms after Pipeline Embolization: Evaluation with Angiography and Optical Coherence Tomography

BACKGROUND AND PURPOSE

Flow diversion with the Pipeline Embolization Device has emerged as an attractive treatment for cerebral aneurysms. Processes involved in aneurysm occlusion include changes in intra-aneurysmal hemodynamics and endothelialization of the device. Here, we call attention to a radiographic sign not previously reported that is detected in incompletely occluded aneurysms after treatment with the Pipeline Embolization Device at angiographic follow-up and referred to as the "collar sign."

MATERIALS AND METHODS

A retrospective review of all patients who underwent placement of a Pipeline Embolization Device for cerebral aneurysms between January 2014 and May 2016 was performed. All aneurysms found to show the collar sign at follow-up were included. Optical coherence tomography was performed in 1 case.

RESULTS

One hundred thirty-five aneurysms were treated in 115 patients. At angiographic follow-up, 17 (10.7%) aneurysms were found to be incompletely occluded. Ten (58.8%) of these aneurysms (average diameter, 7.9 ± 5.0 mm) were found to have the collar sign at angiographic follow-up (average, 5.5 ± 1.0 months). Four (40.0%) of the aneurysms underwent a second angiographic follow-up (average, 11.0 ± 0.9 months) after treatment, and again were incompletely occluded and showing the collar sign. Two patients underwent retreatment with a second Pipeline Embolization Device. Optical coherence tomography showed great variability of endothelialization at the proximal end of the Pipeline Embolization Device.

CONCLUSIONS

The collar sign appears to be indicative of endothelialization, but continued blood flow into the aneurysm. This is unusual given the processes involved in aneurysm occlusion after placement of the Pipeline Embolization Device and has not been previously reported.

Impact of Racial Identity on African American Child-Rearing Beliefs

This study explores the impact of racial identity attitudes on African American parents’ child-rearing beliefs. Specifically, the study seeks to understand differences on family ties, discipline, independence, obedience, and religion according to racial identity attitudes. Participants were 104 parents who were administered the Black Parental Attitude Scale and the Racial Identity Attitude Scale. Results indicate that parents with immersion attitudes endorse discipline and religion but do not support independence in children. Parents with internalization attitudes support all of the Afrocentric parenting beliefs and child-rearing practices included in the study, such as cleanliness, family ties, obedience, religion, and independence in children.

Toward the Development of the Stereotypic Roles for Black Women Scale

Preliminary findings on the validation of the Stereotypic Roles for Black Women Scale (SRBWS) are presented. A sample of 186 African American women took the SRBWS along with the Rosenberg Self-Esteem Scale and the Racial Identity Attitude Scale–B. A confirmatory factor analysis supported a four-factor structure of the scale, and moderate reliability estimates were found for each of the interrelated but distinct subscales. Stepwise regression analyses revealed that Mammy and Sapphire images were significant predictors of self-esteem scores and that the internalized stereotypic roles contributed unique variance over racial identity attitudes in understanding self-esteem in Black women. Suggestions for future research and validation of the SRBWS are discussed.

Racial Identity and Racial Socialization Attitudes of African American Parents

This study explores racial socialization messages used by African American parents, specific messages according to the gender of children, and the relationship between racial socialization and racial identity attitudes as measured by the Racial Identity Attitude Scale. One hundred four African American parents participated in the study. Racial socialization was seen as important to the vast majority of parents and they reported a wide variety of socialization messages. Chi-square analysis suggests that messages differ according to gender. Multiple regression analysis suggests that internalization attitudes contribute to 19% of the variance of racial socialization attitudes, indicating that parents with internalization attitudes are more likely to view racial socialization as important. Implications and limitations of the investigation are discussed, and suggestions for future research are presented.

Racial Identity Attitudes, School Achievement, and Academic Self-Efficacy Among African American High School Students

Literature has postulated that African American students often choose not to succeed in school because achievement is seen as acting White. This study examined the extent to which racial identity, self-esteem, and academic self-concept were related to academic achievementfor 86African American high school students. The majority of students indicated supportfrom both peers and parents for their academic work. Multiple regression analysis indicated that grade point average is best predicted by immersion racial identity attitudes and academic self-concept. Limitations of the present study, implications, and suggestionsforffuture research are presented.

The interrelationship between attentional and executive deficits in major depressive disorder

OBJECTIVE

Cognitive dysfunction is an established feature of major depressive disorder (MDD). However, it remains unclear whether deficits in different cognitive domains are relatively independent or originate from a circumscribed 'primary deficit'. This study tested the hypothesis that a deficit in attention represents a primary deficit in depression.

METHOD

Neuropsychological function was assessed in 30 depressed patients with MDD and 34 control participants. Cognitive composites were derived from a minimum of three tests and included attention, executive function, visuospatial memory and verbal memory. A multivariate analysis of variance was used to assess group differences in overall cognitive performance, and multiple regression models were used to evaluate the role of attention in deficits in other domains.

RESULTS

The cognitive deficit in the depressed sample was found to be characterized by poorer performance in attention and executive function. When evaluating the interrelationship between the two deficits, the attentional deficit was found to persist when variability in executive function was statistically accounted for, whilst the executive deficit was eliminated when attention was accounted for.

CONCLUSION

The results demonstrated that the attentional deficit could not be explained by deficits in executive function, which provides support for a primary attention deficit in depression.

Confirmatory evidence for a multidimensional model of racial-ethnic socialization for transracially adoptive families

OBJECTIVES

The purpose of the current study is to test a recently established model of racial-ethnic socialization (Langrehr, 2014) among 2 samples of White transracially adoptive parents and to assess whether the proposed model functions similarly after accounting for adopted child race.

METHOD

Based on a modified version of the Racial Bias Preparation Scale (Fisher, Wallace, & Fenton, 2000), confirmatory factor analysis was used to test the 3-factor model (i.e., Prejudice Awareness, Racial-Ethnic Pride, and Egalitarianism) among 172 White transracially adoptive parents with Asian children (Mage = 45.72) and 140 White transracially adoptive parents with Black children (Mage = 42.62). In addition, multigroup invariance testing was used to assess whether the proposed model functioned similarly across the 2 groups of parents.

RESULTS

Results indicate that the proposed 3-factor model demonstrated partial measurement invariance such that the subconstruct of Egalitarianism functioned similarly across groups, whereas Racial-Ethnic Pride and Prejudice Awareness were deemed noninvariant.

CONCLUSIONS

Findings are intended to help expand the concept of racial-ethnic socialization for transracially adoptive families and address the degree to which current research on racial-ethnic socialization can be applied to different transracially adoptive families. Results are intended to highlight ways that various social-cultural dimensions of family can culminate into different socialization experiences. (PsycINFO Database Record

Abstract P5-04-13: Pin1 negatively impacts Smad3 tumor suppression in triple negative breast cancer cell lines

Introduction: Triple negative breast cancer (TNBC) is an aggressive subtype associated with poor outcomes. Accordingly, there is an urgent need to develop novel and targeted therapeutics for patients with this disease subtype. Cyclins D and E and the corresponding activation of CDK4/2 represent promising therapeutic targets for the treatment of TNBC. CDK4/2 can non-canonically phosphorylate Smad3, a key TGFβ signaling intermediate, to promote the transition from tumor suppressive to oncogenic TGFβ activity in cyclin-overexpressing breast cancers. We identified a Smad3 interaction with Pin1, a cis-trans isomerase also overexpressed in aggressive breast cancers and associated with CDK-mediated Smad3 phosphorylation. Smad3 interaction with Pin1 can influence protein function and fidelity through recruitment of Smurf2 and subsequent proteasomal degradation. Based on these findings, we hypothesized that inhibition of the CDK-mediated Smad3-Pin1 interaction would stabilize Smad3 protein expression and restore tumor-suppressive Smad3 activity.

Methods: Pin1 expression was knocked-down (KD) in MDA-MB-231 TNBC cells by transfecting with Pin1-targeting siRNA (siPin1) or control non-specific siRNA (siNS). KD efficiency was confirmed by immunoblotting. To assay Smad3 transcriptional activity with Pin1 KD, luciferase reporter studies were performed. Also, following Pin1 KD, immunoblotting was used to determine expression of Smad3 and associated protein targets. MTS assays were utilized to determine cellular proliferation after Pin1 KD. Transwell migration assays were used to assay the effect of Pin1 KD or CDK2 inhibitor treatment, which blocked non-canonical Smad3 Thr179 phosphorylation, on TNBC cell migration.

Results: KD of Pin1 expression in TNBC cell lines resulted in an increase in Smad3 transcriptional activity compared to control cells, and correlated with an increase in expression of cdki p15 and a decrease in c-myc, Smad3-target genes and cell cycle regulators. Additionally, Pin1 KD resulted in a significant decrease in TNBC cell proliferation compared to siNS control TNBC cells. Smad3 protein levels increased following Pin1 KD, suggesting Pin1 action may negatively impact Smad3 stability. We also found that KD of Pin1 or treatment with a CDK2 inhibitor, which blocked Smad3 noncanonical Thr179 phosphorylation, resulted in significantly reduced TNBC cell migration.

Conclusions: Inhibiting the Smad3-Pin1 interaction by knock-down of Pin1 expression in TNBC cells restored Smad3 transcriptional activity, which correlated to an increase in expression of the Smad3 associated protein cdki p15, decrease in c-myc, and a decrease in cellular proliferation. Additionally, Pin1 KD enhanced Smad3 protein levels, suggesting a role of Pin1 in mediating Smad3 stability. Inhibiting the Smad3-Pin1 interaction with Pin1 KD or CDK2 inhibitor treatment also reduced TNBC cell migration. Collectively, these data suggest that the Smad3-Pin1 interaction, facilitated by noncanonical CDK-mediated Smad3 phosphorylation, is associated with pro-tumorigenic and pro-migratory TGFβ signaling, and inhibition of this interaction may provide an important therapeutic option for TNBC patients.

Citation Format: Thomas AL, Hamdan R, Hong A, Rosenthal E, Thomas AJ, Jeruss JS. Pin1 negatively impacts Smad3 tumor suppression in triple negative breast cancer cell lines. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-04-13.

Exome sequencing in dementia with Lewy bodies

Dementia with Lewy bodies (DLB) is the second most common form of degenerative dementia. Siblings of affected individuals are at greater risk of developing DLB, but little is known about the underlying genetic basis of the disease. We set out to determine whether mutations in known highly penetrant neurodegenerative disease genes are found in patients with DLB. Whole-exome sequencing was performed on 91 neuropathologically confirmed cases of DLB, supplemented by independent APOE genotyping. Genetic variants were classified using established criteria, and additional neuropathological examination was performed for putative mutation carriers. Likely pathogenic variants previously described as causing monogenic forms of neurodegenerative disease were found in 4.4% of patients with DLB. The APOE ɛ4 allele increased the risk of disease (P=0.0001), conferred a shorter disease duration (P=0.043) and earlier age of death (P=0.0015). In conclusion, although known pathogenic mutations in neurodegenerative disease genes are uncommon in DLB, known genetic risk factors are present in >60% of cases. APOE ɛ4 not only modifies disease risk, but also modulates the rate of disease progression. The reduced penetrance of reported pathogenic alleles explains the lack of a family history in most patients, and the presence of variants previously described as causing frontotemporal dementia suggests a mechanistic overlap between DLB and other neurodegenerative diseases.

Prodromal dementia with Lewy bodies

BACKGROUND

The clinical condition of dementia is now recognized as a diagnosis that can only be applied too late in the disease process to be useful for therapeutic approaches centring on disease modification. As a result, in recent years increasing attention has been given to mild cognitive impairment (MCI) and the diagnosis of prodromal dementia. This paper reviews the evidence for the clinical presentation of prodromal dementia with Lewy bodies (DLB).

METHOD

A Medline search was carried out to identify articles with original data on the prodromal presentation of DLB.

RESULTS

In MCI cohorts that progress to dementia, the proportion diagnosed with DLB is similar to that reported in dementia cohorts. Prodromal DLB may present as any MCI subtype, although visuospatial and executive domains may be most commonly affected. Rapid eye movement (REM) sleep behaviour disorder (RBD), autonomic symptoms, hyposmia, hallucinations and motor symptoms seem to be more common in prodromal DLB than in prodromal Alzheimer's disease (AD). Some of these symptoms can precede the diagnosis of DLB by several years. There has been little research into the use of biomarkers in prodromal DLB, although in RBD cohorts, clinical and imaging biomarkers have been associated with the development of DLB.

CONCLUSIONS

The evidence available suggests that prodromal DLB may be differentiated from other dementia prodromes in most cases. Further research is needed to confirm this, and to assess the utility of biomarkers such as 123I-FP-CIT and 123I-MIBG imaging.

The Influence of the Trayvon Martin Shooting on Racial Socialization Practices of African American Parents

Many perceived the death of Trayvon Martin as racially motivated. We hypothesized that hearing about the death of Trayvon Martin also had an effect on African American parents. This qualitative investigation explored African American parents’ perceptions of the death of Trayvon Martin and how it affected the provision of racial socialization. The analysis indicated that a number of parents felt that Trayvon Martin’s death was a form of racial profiling and that young Black men needed to be protected. Participants were also worried about their children after the shooting and took approaches to explaining the shooting that involved discussing the presence of racism, framing it as an individual violent incident, as well as engaging in emotional processing with their children. Finally, parents also provided suggestions on what their children should do if they were placed in a similar situation. These included obtaining help, getting away from the perpetrator, being respectful to the perpetrator, and engaging in self-defense.

Linking Contextual Affordances

This exploratory investigation examined the link between self-reported racial–ethnic socialization experiences and perceived parental career support among African American undergraduate and graduate students. The results of two separate multivariate multiple regression analyses found that messages about coping with racism positively predicted parental career supports involving opportunities to practice career behaviors, modeling of career behaviors, verbal encouragement of career development, and providing emotional support. Messages involving intergroup interactions were positively predictive of emotional support messages and opportunities to practice career development activities. The self-report of exposure to African American cultural artifacts (i.e., nonverbal ethnic socialization) positively predicted parental modeling of career behaviors and verbal encouragement of career development. Messages about African American history positively predicted verbal encouragement of career development and emotional support. Finally, messages about engaging in African American cultural activities negatively predicted verbal encouragement of career development. Recommendations for research and practice are provided.

Factor Analysis of the Parent Experience of Racial Socialization Scale

This investigation examined the factor structure and validity evidence for the Parent Experience of Racial Socialization Scale (PERS). Exploratory factor analysis found four interpretable factors accounting for 40% of the variance in the racial socialization construct. The identified factors were religion and spirituality, alertness to discrimination, mainstream, and cultural pride and coping. Correlation analyses indicated negative relationships between the newly identified PERS factors religion and spirituality and alertness to discrimination and the Teenagers Experiences of Racial Socialization (TERS) factor Alertness to Discrimination. In contrast, a positive relationship was found for the PERS spirituality and religion factor and the TERS cultural endorsement of the mainstream factor. Recommendations for research methods regarding racial socialization scales are provided.

Contextual Influences on Gendered Racial Identity Development of African American Young Women

The aim of the study was to identify the contextual factors and socialization experiences most salient to the identity development of African American girls. Seventeen African American young women participated in dyadic focus groups. Themes that emerged included exposure to stereotypes, negative classroom environments, and parental and peer socialization that fostered self-determination and positive identity development. Implications for interventions and future research are included.

I'm No Jezebel; I am Young, Gifted, and Black: Identity, Sexuality, and Black Girls

Scholars have highlighted the detrimental influence of racially charged stereotypes and images on self-perception and well being. Others have suggested that identity components (e.g., ethnic identity and self-concept) serve a protective function. The purposes of this study were (a) to explore the relationship among stereotypic images, beauty standards that are consistent with “colorism,” and identity components of African American girls and (b) to determine the impact of these variables on girls' sexual attitudes. African American girls ( N = 270) between the ages of 10–15 years old completed a self-report questionnaire, which included a new measure, the Modern Jezebel Scale, that was used to assess stereotypic images. A series of multiple regressions were performed using identity components, stereotypic images, and colorism as independent variables and sexual attitude variables as the outcome. In addition, interaction effects were explored to determine if identity components moderated the influence of stereotypic images and colorism on sexual attitudes. As expected, findings revealed significant positive relationships among stereotypic images, colorism, and sexual risk. In addition, significant interactions were found between identity components and stereotypes. Instead of identity serving as a buffer against the negative effects of societal messages, endorsement of stereotypes and colorism increased sexual risk in the context of identity components. Results suggest that a strong identity may not be enough to reduce sexual risk if girls cannot critically analyze the societal messages that they receive. Implications for prevention efforts are discussed.

The pattern and course of cognitive impairment in late-life depression

BACKGROUND

Cognitive deficits persist despite clinical recovery in subjects with late-life depression, but more needs to be known about their longer-term outcome and factors affecting their course. To investigate this, we followed the pattern of cognitive impairments over time and examined the effects of current mood, remission status, age of depression onset and antidepressant (AD) treatment on these deficits.

METHOD

Sixty-seven subjects aged > or = 60 years with DSM-IV major depressive disorder and 36 healthy comparison subjects underwent tests of global cognition, memory, executive functioning and processing speed at baseline, 6 and 18 months, with some subjects tested again after 4 years. z scores were compared between groups, with analyses of clinical factors that may have influenced cognitive performance in depressed subjects.

RESULTS

Half of the patients exhibited a generalized cognitive impairment (GCI) that persisted after 18 months. Patients performed worse across all cognitive domains at all time points, without substantial variability due to current mood, remission status or AD treatment. Late age of onset was associated significantly with decline in memory and executive functioning. Impaired processing speed may be a partial mediator of some deficits, but was insufficient to explain differences between patients and controls. Four-year follow-up data suggest impairments persist, but do not further decline.

CONCLUSIONS

Cognitive deficits in late-life depression persist up to 4 years, affect multiple domains and are related to trait rather than state effects. Differences in severity and course between early and late onset depression suggest different pathogenic processes.

A comparison of neurocognitive impairment in younger and older adults with major depression

BACKGROUND

Neurocognitive impairment is a well-recognized feature of depression that has been reported in younger and older adults. Similar deficits occur with ageing and it is unclear whether the greater deficits in late-life depression are an ageing-related phenomenon or due to a difference in the nature of late-life depression itself. We hypothesized that ageing alone would not fully explain the increased neurocognitive impairment in late-life depression but that differences in the illness explain the greater decrements in memory and executive function.

METHOD

Comparison of the neuropsychological performance of younger (<60 years) and older (60 years) adults with major depressive disorder (MDD) and healthy comparison subjects. Scores for each depression group were normalized against their respective age-matched control group and the primary comparisons were on four neurocognitive domains: (i) attention and executive function; (ii) verbal learning and memory; (iii) visuospatial learning and memory; and (iv) motor speed.

RESULTS

We recruited 75 subjects with MDD [<60 years (n=44), 60 years (n=31)] and 82 psychiatrically healthy comparison subjects [<60 years (n=42), 60 years (n=40)]. The late-life depression group had greater impairment in verbal learning and memory and motor speed but not in executive function. The two depressed groups did not differ in depression severity, global cognitive function, intelligence or education.

CONCLUSIONS

Late-life depression is associated with more severe impairment in verbal learning and memory and motor speed than depression in earlier adult life and this is not due to ageing alone.

The MR imaging appearance of the vascular pedicle nasoseptal flap

BACKGROUND AND PURPOSE

Recently, surgeons have used an expanded endonasal surgical approach (EENS) to access skull base lesions not previously accessible by minimally invasive techniques. Reconstruction of the large skull base defects created during EENS is necessary to prevent postoperative CSF leaks. A vascular pedicle nasoseptal mucoperiosteal flap based on the nasoseptal artery, (Hadad-Bassagasteguy flap) is becoming a common reconstructive technique. The purpose of this study was to review the expected MR imaging appearance of these flaps and to discuss variations in the appearance that may suggest potential flap failure.

MATERIALS AND METHODS

We retrospectively reviewed 10 patients who underwent EENS for resection of sellar lesions with skull base reconstruction by multilayered reconstruction including the Hadad-Bassagasteguy flap. All patients had preoperative, immediate, and delayed postoperative MR imaging scans. Flap features that were evaluated included flap configuration, signal intensity characteristics on T1-weighted and T2-weighted images, enhancement patterns, location, and flap thickness.

RESULTS

All patients had detectable postoperative skull base defects. All patients had C-shaped configuration flaps within the operative defect, which were isointense on T1-weighted and T2-weighted images on both immediate and delayed postoperative MR imaging scans. On the immediate scans, 8 of 10 patients had enhancing flaps and 2 of 10 had minimal to no enhancement. There were 9 of 10 patients who had enhancing flaps on delayed scans, and 2 of 10 patients had flaps that increased in enhancing coverage on the delayed scans.

CONCLUSIONS

Vascular pedicle nasoseptal flaps have a characteristic MR imaging appearance. It is important for the radiologist to recognize this appearance and to evaluate for variations that may suggest potential flap failure.

Risk of hemorrhage in combined neuroform stenting and coil embolization of acutely ruptured intracranial aneurysms

SUMMARY

Stenting as adjuvant therapy for the coiling of acutely ruptured aneurysms remains controversial due to the necessity of anticoagulation and antiplatelet medications. We report our experience using the Neuroform stent in the management of 41 aneurysms in 40 patients over a period of three years. For aneurysms whose open surgical risk remains excessive with a morphology that would preclude complete embolization, the risks of stenting may be warranted.

Apophysomyces elegans - renal mucormycosis in a healthy host: a case report from south India

Zygomycosis is an opportunistic fungal infection that seldom occurs in individuals with a competent immune system. Isolated involvement of any organ is rare and only a few cases of renal zygomycosis have been reported. We present an unusual case of renal zygomycosis caused by Apophysomyces elegans in a patient with no known predisposing factor. He presented with flakes in the urine and was found to have a poorly functioning right kidney. Ureterorenoscopy was performed, fungal elements removed and pathological confirmation obtained. The patient subsequently underwent nephrectomy after treatment with amphotericin B. He made an uneventful recovery.

Factors predicting hemorrhagic complications after multimodal reperfusion therapy for acute ischemic stroke

BACKGROUND AND PURPOSE

We sought to find predictors for hemorrhagic complications in patients with acute ischemic stroke treated with multimodal endovascular therapy.

MATERIALS AND METHODS

We retrospectively reviewed patients with acute ischemic stroke treated with multimodal endovascular therapy from May 1999 to March 2006. We reviewed clinical and angiographic data, admission CT Alberta Stroke Programme Early CT Score (ASPECTS), and the therapeutic endovascular interventions used. Posttreatment CT scans were reviewed for the presence of a parenchymal hematoma or hemorrhagic infarction based on defined criteria. Predictors for these types of hemorrhages were determined by logistic regression analysis.

RESULTS

We identified 185 patients with a mean age of 65+/-13 years and mean National Institutes of Health Stroke Scale score of 17+/-4. Sixty-nine patients (37%) developed postprocedural hemorrhages: 24 (13%) parenchymal hematomas and 45 (24%) hemorrhagic infarctions. Patients with tandem occlusions (odds ratio [OR] 4.6 [1.4-6.5], P<.016), hyperglycemia (OR 2.8 [1.1-7.7], P<.043), or treated concomitantly with intravenous (IV) tissue plasminogen activator (tPA) and intra-arterial (IA) urokinase (OR 5.1 [1.1-25.0], P<.041) were at a significant risk for a parenchymal hematoma. Hemorrhagic infarction occurred significantly more in patients presenting with an ASPECTS

CONCLUSIONS

Hemorrhagic infarctions are related to the extent of infarct based on presentation CT, whereas parenchymal hematomas are associated with the presence of tandem occlusions, hyperglycemia, and treatment with both IV tPA and IA urokinase in patients with acute stroke treated with multimodal endovascular therapy.

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Key Words Collapse

MESH Headings

• Acute Disease
• Aged
• Brain Ischemia/epidemiology
• Brain Ischemia/therapy
• Cerebral Hemorrhage/epidemiology
• Comorbidity
• Female
• Humans
• Male
• Middle Aged
• Pennsylvania/epidemiology
• Prevalence
• Reperfusion/statistics & numerical data
• Risk Assessment/methods
• Risk Factors
• Stroke/epidemiology
• Stroke/therapy
• Treatment Outcome

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Grants Collapse

Stenting and angioplasty of the symptomatic chronically occluded carotid artery

Patients with hemodynamic impairment ipsilateral to a carotid occlusion are at a high risk of subsequent stroke, and currently 2 surgical options have been studied: extracranial-to-intracranial bypass and direct thromboendarterectomy. We report the successful revascularization of 2 symptomatic chronically occluded carotid arteries with stenting and angioplasty.

A study of the serotonin transporter in the prefrontal cortex in late-life depression and Alzheimer's disease with and without depression

Previous studies investigating the serotonin transporter (SERT) in depression have been inconsistent and included a large proportion of subjects who had committed suicide. In Alzheimer's disease studies have generally reported a reduction in SERT density but have not compared Alzheimer's disease subjects with and without comorbid major depression. We conducted a post mortem study of SERT density in the prefrontal cortex in normal elderly, a group of elderly depressed subjects and in Alzheimer's disease subjects with and without major depression. A post mortem study comparing SERT density in the prefrontal cortex in elderly controls (n = 10), subjects with major depression (n = 8) and subjects with Alzheimer's disease with (n = 9) and without (n = 5) comorbid major depression. We used autoradiography to measure the density of [3H]CN-IMI binding (non-specific binding determined with citalopram) to the SERT in the prefrontal cortex. We found a marked reduction in specific SERT binding in the prefrontal cortex in Alzheimer's disease subjects compared with both control (P = 0.002) and depressed subjects (P = 0.004) but no difference in SERT binding between depressed and control subjects or between Alzheimer's disease subjects with and without depression. Our study confirms previous reports of a reduction in SERT binding in Alzheimer's disease but indicates this reduction is not greater in Alzheimer's disease subjects who also have had major depression. In a group of subjects more typical of late-life depression we did not identify any alterations in SERT density.

Relationship of interleukin-6 with semen characteristics and oxidative stress in vasectomy reversal patients

This prospective study was performed to evaluate the relationship between interleukin-6 (IL-6), oxidative stress and sperm function following vasectomy reversal. We included 22 patients who underwent vasectomy reversal and 15 healthy sperm donors (controls) with normal sperm morphology criteria. Levels of IL-6 in the semen were measured by the enzyme-linked immunosorbent assay, and levels of reactive oxygen species (ROS) and total antioxidant capacity were measured by the chemiluminescence assay. The mean sperm concentration in the vasectomy reversal group was significantly lower than control group (45.3 +/- 39.1 versus 63.1 +/- 28.5; P = 0.02). Motility was also significantly lower in the vasectomy reversal group (32.1 +/- 19.9 versus 54.6 +/- 18.9; P = 001). Levels of IL-6 were significantly higher in the vasectomy reversal group (2.09 +/- 0.87 versus 0.99 +/- 0.97; P = 0.007) as were mean ROS levels (2.25 +/- 0.97 versus 1.2 +/- 0.7; P = 0.009). Significant positive correlation was observed between the IL-6 and ROS levels in vasectomy reversal patients compared with donors (r = 0.41, P = 0.05 versus r = 0.38, P = 0.15). We conclude that patients who undergo vasectomy reversal have elevated levels of IL-6 and ROS, which may contribute to decreased sperm motility and concentration and possibly lead to sub-fertility.

Relationship of neonatal body composition to maternal glucose control in women with gestational diabetes mellitus

OBJECTIVE

To determine whether neonatal fat mass, which may be a better estimate of fetal overgrowth, is correlated with maternal fasting, preprandial and/or postprandial glucose values in women with gestational diabetes mellitus (GDM).

STUDY DESIGN

Women with GDM and no other medical or obstetric problems, and their infants, were the subjects of this study. Portable reflectance meters were used by all participants for self-monitoring of blood glucose levels. Average fasting, preprandial, 2-h postprandial and bedtime glucose values were determined for each subject. Neonatal body composition was obtained by total body electric conductivity and/or anthropometric measurements within 48 h after delivery.

RESULTS

Eighteen women with their infants participated in this study. The age (mean +/- SD) of the mothers was 28.0 +/- 5.7 years. Nine were treated with diet and nine with diet and insulin. An average of 40 fasting (84 +/- 13 mg/dl), 50 preprandial (87 +/- 14 mg/dl), 80 2-h postprandial (106 +/- 19 mg/dl) and 17 bedtime (104 +/- 19 mg/dl) glucose values were obtained from each subject. The average gestational age of the infants at birth was 38.3 +/- 1.3 weeks with a mean weight of 3,356 +/- 526 g. Three infants were > 4 kg and seven infants were > 90th centile for gestational age. The strongest correlation with neonatal fat mass was maternal fasting glucose level (r = 0.71, p < 0.01). Neonatal fat mass was not found to be significantly correlated with any other mean glucose value. Additionally, the infant's per cent body fat (r = 0.71, p < 0.01), sum of skinfold thicknesses (r = 0.70, p < 0.01), fat-free mass (r = 0.50, p < 0.05), and weight (r = 0.61, p < 0.01) were also found to be correlated with maternal fasting glucose level. No other maternal glucose measurements were correlated with either birth weight or estimates of fat free mass.

CONCLUSION

Maternal fasting glucose levels correlated best with neonatal fat mass and other estimates of neonatal body composition.

Differential production of reactive oxygen species by subsets of human spermatozoa at different stages of maturation

BACKGROUND

Reactive oxygen species (ROS)-mediated damage to human spermatozoa has been implicated in the pathogenesis of male infertility. Although ROS production by human spermatozoa has been extensively studied, the cell-to-cell variation in ROS production by spermatozoa at different stages of maturation has never been investigated.

METHODS

In this study, we determined ROS production by subsets of human spermatozoa at different stages of maturation isolated by density gradient centrifugation of ejaculated spermatozoa obtained from healthy donors and from patients attending a clinic for infertility screening.

RESULTS

Four different fractions were obtained. ROS production was highest in immature spermatozoa with abnormal head morphology and cytoplasmic retention and lowest in mature spermatozoa and immature germ cells (P < 0.01). ROS production was highest in immature spermatozoa from males with abnormal semen parameters compared with donors (P < 0.0001) or patients with normal semen parameters (P = 0.015). ROS production by immature spermatozoa was inversely correlated with the recovery of motile, mature spermatozoa in the high density fraction 4 (P = 0.01).

CONCLUSIONS

The results of this study indicate that there is significant cell-to-cell variation in ROS production in subsets of spermatozoa at different stages of maturation and that oxidative damage of mature spermatozoa by ROS-producing immature spermatozoa during sperm migration from the seminiferous tubules to the epididymis may be an important cause of male infertility.